Causes Voice strain and nodules are caused by stress to the larynx, within which are the delicate vocal cords. Classically, children with nodules are in the habit of talking too long, too loudly and with too much effort. Mouth breathing is also potentially drying. A simple way of checking for adequate fluid intake is to ensure that urine is pale in colour.
Some children are more vulnerable to developing vocal nodules and vocal strain than others.
Some babies just seem to be born loud and lovable, and grow into loud and lovable toddlers and children, some of whom are, unfortunately, 'at risk' for voice problems.