BREASTFEEDING : RELATIONS WITH SUCKING HABITS AND SOCIOECONOMIC ASPECTS OF THE FAMILY Aleitamento : relação com hábitos de sucção e aspectos socioeconômicos familiares

(1) Graduate Program in Human Communication Disorders, Federal University of Santa Maria UFSM, Santa Maria, RS, Brazil. (2) Federal University of Santa Maria UFSM, Santa Maria, RS, Brazil. (3) Federal University of Santa Maria UFSM, Santa Maria, RS, Brazil. (4) Graduate Program in Human Communication Disorders, Federal University of Santa Maria UFSM, Santa Maria, RS, Brazil. Conflict of interest: non existent of the stomatognathic system (SS), and plays an important role in the intellectual and emotional development of the child. It also influences on the emotional relationship with the mothers, but the early interruption can still be observed 2-5. This interruption of breastfeeding, besides bringing alterations to the SS, may favor the emergence of sucking habits, as with the bottle, having the possibility of finger introduction in the mouth, or the use of a pacifier 6,7. This is because when using the bottle, the perioral muscles are not as stimulated as in the sucking of breast milk, thus, children often tend to seek another type of suction, as the finger or a pacifier, in order to be satisfied nutritionally and/or emotionally 3. This way, the presence of sucking habits may compromise the orofacial muscles and craniofacial  INTRODUCTION

is understood by supply of other food to introduce porridge, teas, juice, water, among others.
As for milk feeding duration, three categories were also considered for breast and artificial feeding: none or little, when the child was breastfed until six months of age; up to two years, when the child was fed between six months and two years old; and over two years, when the child was offered milk feeding for more than two years.To calculate the times of breast and bottle feeding, it was considered what occurred exclusively and mixed.
For sucking habits, it was considered the use and time of pacifiers and finger sucking.As for the types of feeding (maternal and artificial), for these habits, the children were divided into three ranges (0 to 6 months; 6 months 1day up to 2 years; over 2 years).
Regarding socioeconomic aspects (family income and mother's education), for the monthly family income it was considered the following ranges adapted from IBGE 14 : no income or up to 1 minimum salary; from 1.1 minimum salary to 5 minimum salaries; 5.1 minimum salaries up to 10 minimum salaries; and more than 10 minimum salaries.For the mother's education, the following conditions were considered: illiterate; with incomplete or complete primary education; with incomplete or complete high school and with incomplete or complete university education.
This study was approved in the Federal University of Santa Maria Research Ethics Committee -CEP/ UFSM, under protocol number 0223.0.243.000-10.
The studied variables were descriptively and statistically analyzed.The Software Statistical Package for Social Science 15.0 (SPSS) was used for the statistical analysis of the data.It was used the Chi-square test for the relations between the variables type of milk feeding, duration of breastfeeding, duration of artificial feeding, sucking habits, family monthly income and maternal education.It was used a significance level of 5% (p <0.05) in the statistical analyses.

RESULTS
Descriptive data on the variables: type of milk feeding, duration of breastfeeding, duration of artificial feeding, pacifiers, pacifier period, finger sucking, finger sucking period, family monthly income and mother's education.
growth and development, depending on the period, intensity and frequency with which it is done 8 .
Early weaning and the consequent introduction of the bottle are still present among mothers who breastfeed, which may be linked to several causes, among them cultural factors as the myth of poor or insufficient milk 9,10 .Besides these factors, the socioeconomic aspects such as family income, education level of the mother, lack of information about the advantages of breastfeeding, end of maternity leave and return to work can be linked to early weaning [11][12][13] .
Taking into account the facts above, and considering the importance of breastfeeding for the child, the aim of this study was to characterize the type and duration of breastfeeding and to verify the relationship between these variables and suction habits and family socioeconomic aspects.

METHODS
This research was conducted with children from eight public and private schools from Agudo -Rio Grande do Sul.The sample consisted of participants of both sexes, aged between five and eight years and 11 months old.The parents or people responsible for the children signed an Informed Consent Form (ICF).After signing it, the responsibles for the 220 children filled out a previously prepared questionnaire.
The inclusion criterion for this study was to be aged between five and eight years and 11 months old.The questionnaires with incomplete responses were excluded from the study, and only 195 were used for the data analysis.
With regard to the questions asked, the following data were collected: children's identification data, as well as data regarding the type and duration of the breastfeeding received, deleterious oral habits (pacifier and finger sucking) and socioeconomic aspects (family monthly income and maternal education).
Regarding the type of feeding, the children in the sample were divided into three categories: breastfeeding only (considered children who were breastfed and not fed by bottle, independent of supply of other food); artificial feeding only (considered children who received bottle and were not breastfed, regardless of the supply of other food) or mixed, when both kinds were offered.It sucking period, family monthly income and mother's education.
The time of artificial milk feeding was also associated to the variables: time of artificial feeding, pacifiers, pacifier period, finger sucking, finger sucking period, family monthly income and mother's education.
The type of milk feeding was associated to the variables: duration of breastfeeding, duration of artificial feeding, pacifier, pacifier period, finger sucking, finger sucking period, family monthly income and mother's education.
The duration of breastfeeding was associated in this study to the variables: time of artificial feeding, pacifiers, pacifier period, finger sucking, finger   The extended use of bottle-feeding, explicit in this study as artificial feeding, can be verified in this study, since 66.2% of the children used it for over two years (Table 1).It is known that by sucking the breast the milking motion occurs, which favors the proper lip closure and correction of physiological mandibular retrognathia.Besides that, it benefits the correct positioning of the tongue, through the adapting of tonicity due to its intense muscular activity 2,15 .When the bottle is introduced and its use remains for a long period, this movement is impaired, interfering with the development of orofacial functions and structures 16,17 .
Moreover, the introduction of bottles may stimulate the emergence of other deleterious oral habits, since the child does not meet his/her needs of sucking and eventually acquires non-nutritive sucking habits, such as the pacifier or finger sucking 2,3,6 .In this study, the use of the bottle, beyond two years of age, may have been decisive in the presence of the pacifier for most children, which was used for a prolonged period (Table 1).As for finger sucking, a minority of children had this habit, probably because most of them already used the DISCUSSION This research found that there was a prevalence of the mixed type of milk feeding, but it was observed that the use of breastfeeding only was higher than the artificial feeding only (Table 1), this predominance of the mixed feeding was also observed by other authors 8 .
Regarding the duration of feeding, there was a relation among them.Of the children who received the bottle for a period exceeding two years, the majority did not receive breastfeeding or received it for a short period.On the other hand, children who had a higher offer of breastfeeding had little bottle usage.
Several reasons may lead to the introduction of the bottle, the concern with the babies' nutrition, their crying, opinions that the milk is weak and insufficient 9,10 and lack of information about the benefits of breastfeeding are some of them 11 .Besides these aspects, the end of maternity leave, the mother's return to work, the income and the degree of education 12,13 are generally related to this moment.to the effort that the muscles exert during breastfeeding.The unmet psycho-emotional needs due to inadequate time for breastfeeding and the introduction and extended use of bottles, may lead the child to meet those needs using devices such as pacifiers or their own thumb 3,22 .
Several studies found a relationship between the presence of habits and early weaning, as well as the continuation of artificial feeding 17,23,24 , which is in agreement with the results of this study.
When comparing type and duration of breastfeeding with family socioeconomic aspects, it was found that there was no statistical significance, except for the relation between type of milk feeding and family income.It was observed that most of the mothers who offered the bottle, either exclusively or mixed form, were in a range of low monthly income.
Some authors report that mothers belonging to higher social classes, with higher education and more affluent, perform breastfeeding with greater frequency 25 due to easier access to information on the subject.This can be observed in a study with 30 mothers, where those who breastfed their children for longer, were those with more education and higher family monthly income 26 .

CONCLUSION
It can be concluded that the mixed type of feeding predominated, but it was found that exclusive breastfeeding begins now to appear more than the artificial feeding only, however, when this occurs it remains for an extended period.Furthermore, the type and duration of milk feeding were decisive in acquiring the pacifier habit, and social levels of lower income may be considered predictors for the insertion of other forms of milk feeding, rather than the natural.pacifier, satisfying their will for sucking.Thus, even if the finger sucking habit was not common among these children, the majority used the pacifier, which can interfere in the facial and dental arch growth and development, and may negatively influence the morphology of the hard palate and the mobility and tension of the tongue and lips 18 .
With regard to socioeconomic aspects, it was observed that a large part of the families did not have any income or received up to one minimum salary per month.Corroborating these findings, another study analyzing early weaning, showed that the monthly income of most households was up to a minimum salary 19 .This study also found that there was a predominance of mothers with incomplete or complete elementary school, meeting the present research findings.This predominance was also observed in another study 20 .
The high educational level of mothers has been linked to successful maternal breastfeeding 21 , which may be related to their education, as those with high education levels are generally well informed about the benefits of breastfeeding and the losses of the artificial feeding.
Regarding the relations investigated, there was relation between the variables type of milk feeding, breastfeeding and artificial feeding duration among each other; as well as between them and the variables: family income, pacifier and its period.
It was observed, in this study, that children who were breastfed for a short time, as well as those who had extended artificial or mixed feeding, developed the use of the pacifier for a longer time.Those who were breastfed for a longer period and did not have the insertion of the bottle did not develop the pacifier habit.

Table 1 -Frequency distribution of absolute (n) and relative (%) values of the variables, type of milk feeding, duration of breastfeeding, duration of artificial feeding, pacifier use, pacifier period, finger sucking, finger sucking period, family monthly income and mother's education
Legend: 0 -6m -did not receive/use or up to 6 months; 6m -2y -received/used from 6 months to 2 years; + 2y -received/used for over 2 years; Elem.Sc.I/C -Incomplete or Complete Elementary School; High Sc.I/C -Incomplete or Complete High School; University I/C -Incomplete or Complete university studies (undergraduate studies)

Table 2 -Distribution of absolute (n) and relative values (%) of the relations between type of milk feeding and the variables duration of breastfeeding, duration of artificial feeding, pacifier use, pacifier period, finger sucking, finger sucking period, family monthly income and maternal education Variables Type of milk feeding p -value Maternal Brestfeeding Only
Legend: 0 -6m -did not receive/use or up to 6 months; 6m -2y -received/used from 6 months to 2 years; + 2y -received/used for over 2 years; Elem.Sc.I/C -Incomplete or Complete Elementary School; High Sc.I/C -Incomplete or Complete High School; University I/C -Incomplete or Complete university studies (undergraduate studies); * Significance Level of 1% p<0,01; ** Residue Analysis by the Chi-square test.