BRIEF RESEARCH REPORT article
Front. Pediatr.
Sec. Pediatric Pulmonology
Psychological Factors Contributing to Vocal Cord Dysfunction in Pediatric Population Pre-Pandemic and During Pandemic
Provisionally accepted
- 1Nemours Children's Clinic, Orlando, United States
- 2Baylor University Medical Center, Dallas, United States
- 3Mayo Clinic in Florida, Jacksonville, United States
- 4University of North Carolina, Chapel Hill, United States
- 5Nemours Children's Hospital, Orlando, United States
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Background: Vocal cord dysfunction (VCD) is an underrecognized differential diagnosis for asthma and is often influenced by psychological factors. The COVID-19 pandemic introduced new stressors and disrupted access to pediatric care, potentially affecting VCD incidence and recognition. Objectives: This study aimed to determine whether the incidence of pediatric VCD at Nemours Children's Hospital in Orlando changed during the COVID-19 pandemic and to identify psychological diagnoses most associated with VCD. Methods: A retrospective chart review was conducted for patients diagnosed with VCD between January 2017 and July 2022, including 2.5 years before and 2.5 years during the pandemic. Demographics, diagnostic methods, triggers, comorbidities, and psychological conditions were extracted from the electronic medical record. Results: Among 74,022 patients (45,199 pre-pandemic; 28,823 pandemic), VCD incidence significantly decreased during the pandemic (0.7% vs. 0.3%, p < 0.001). Psychological diagnoses also declined modestly: anxiety (2.6% vs. 2.0%), depression (0.3% vs. 0.2%), and ADHD (4.4% vs. 3.5%). Compared with non-VCD patients, those with VCD were older (median 14 vs. 9 years), predominantly female (71% vs. 47%), and more often White/non-Hispanic. They had higher rates of asthma (41% vs. 16%), allergic rhinitis (20% vs. 11%), gastroesophageal reflux (31% vs. 4%), and psychological conditions, including anxiety (8.5% vs. 2.3%), depression (1.5% vs. 0.2%), and panic attacks (0.8% vs. 0.1%). Conclusions: In contrast to prior reports, VCD incidence declined during the pandemic, likely reflecting reduced healthcare access or underdiagnosis. Persistent associations with psychological conditions highlight the biopsychosocial nature of VCD and the importance of multidisciplinary evaluation in pediatric populations.
Keywords: Anxiety and depression, COVID-19 pandemic, health care utilization, induciblelaryngeal obstruction, pediatric asthma misdiagnosis, psychological comorbidities, retrospective chart review, Vocal cord dysfunction (VCD)
Received: 02 Oct 2025; Accepted: 29 Jan 2026.
Copyright: © 2026 Navas Nazario, Singam, Li, Rapp and Livingston. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Aledie Navas Nazario
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