Common things are:
such as croup
. These are usually self-limiting lasting just a few days.
-gerd or gastroesophageal reflux disease
. All babies have reflux, but when the acid starts to cause a problem such as heartburn
or hoarseness, that is a sign that the baby might need an acid blocker.
-vocal nodules "screamer's nodules" or polyps are the most common cause of hoarseness in kids, but is a little less likely in a 4 month old.
-foreign bodies. Kids put everything in their mouths and occasionally will swallow something that gets lodged in their larynx (voice box). Parents may notice a choking episode prior to the hoarseness and difficulty breathing afterwards.
- more common in older kids with allergies
or hay fever
Uncommon things are:
-vocal cord paralysis
- having one vocal cord that doesn't work
-laryngeal papillomas - little warts
on the vocal cords
-hemangiomas - a collection of blood vessels that cause a lump on the vocal cords
-hypothyroidism - low thyroid hormone
-laryngeal webs and cysts - anatomic problems that affect how the vocal cords work
-bacterial or fungal infection
- very rare in a child with a normal immune system and up-to-date immunizations. These kids look very very sick, also.
It is worth calling your child's doctor to dicuss this problem with them. If this problem persists and they are unable to find the reason why, they may want to send you to a pediatric ear, nose and throat specialist for a more in-depth work-up and evaluation.
Legal disclaimer: I am providing this general and basic information as a public service and my response to this question does not constitute a doctor-patient relationship. For any additional information, advice, or specific concerns, please speak with your own physician. The information provided is current as of the date of the answer entry.