This thesis used a multi-methods approach to explore children’s out-of-school physical activity (PA). Study 1 found that children living in the most deprived neighbourhoods represent an important target group for future PA and health interventions. Further, the study also revealed that self-reported PA was positively associated with independent mobility. Study 2 confirmed that the weekend was a period of low moderate-to-vigorous PA (MVPA), and revealed that raw PA levels derived from the wrist-worn GENEActiv are not comparable with hip-worn ActiGraph. Agreement between the devices differed according to PA intensity and time of day, with the greatest difference occurring in light PA (LPA) during school hours. Using children’s recounted perceptions and experiences of out-of-school PA, study 3 demonstrated how an inclusive, interactive and child-centred methodology (i.e., write, draw show and tell; WDST) may be advantageous when compared to traditional singular qualitative methods. In study 4 parental safety concerns were reported to be the most consistent barrier to children’s out-of-school PA. The family case studies demonstrated how family perceptions and constraints can influence children’s out-of-school PA levels and activity mode (i.e., active school travel, outdoor play and organised sport). Such constraints include factors such as, school proximity, neighbourhood perceptions and family context. Study 5 revealed substantial intra-individual variability in children’s weekend MVPA. PA diary data revealed that children's weekend PA was mostly unstructured in nature and undertaken with friends, whereas a greater proportion of parents’ weekend PA was undertaken alone in structured settings. Family case studies demonstrated that in the selected cases MVPA levels and variability across weekends were contingent on mode of PA participation. This thesis contributes evidence to inform future out-of-school PA interventions. The research has demonstrated that children’s out-of-school PA is influenced by a complex interaction of individual, social and environmental factors. Specific highlights include the family and neighbourhood environment. The weekend is associated with low PA and as such represents an important time period to promote PA in children. Future weekend PA interventions should target specific modes of activity, as the facilitators and barriers to these activities vary considerably. Moreover, in future, research and practice should focus on ways in which to modify neighbourhood attributes to support children’s out-of-school active living.

Childhood onset growth hormone deficiency (CO-GHD) may contribute to low bone mass and alterations to body composition. This thesis consists of a series of studies utilising dual-energy X-ray absorptiometry (DXA), peripheral quantitative computerized tomography (pQCT) and biochemical assessment of bone health and body composition of CO-GHD. In addition, metabolic profiles, glucose metabolism as well as quality of life have been studied in these subjects. Furthermore, an interventional study of weight bearing exercise (WBE) was performed to explore its role in influencing the bone health of children and adolescents with CO-GHD. Chapter 1, relevant literature reviews explore: bone structure, growth, development and strength; GH/IGF-1 system and its actions; CO-GHD and its impacts during childhood and transition; and WBE and its mechanism and impacts on bone health. Chapter 2 presents the rationale and specific aims of this thesis. Chapter 3, a retrospective multicentre review of management of young adults with CO-GHD in four paediatric centres in Scotland during transition. Medical records of 130 eligible CO-GHD adolescents (78 males), who attained final height between 2005-2013 were reviewed. Of the 130, 74/130(57%) had GH axis re-evaluation by stimulation tests /IGF-1 measurements. Of those, 61/74(82%) remained GHD with 51/74(69%) restarting adult rhGH. Predictors of persistent GHD included an organic hypothalamic-pituitary disorder and multiple pituitary hormone deficiencies (MPHD). Despite clinical guidelines, there was significant variation in the management of CO-GHD in young adulthood across Scotland. Chapter 4, a cross-sectional control study of bone DXA measurements in (n=21) subjects with CO-GHD treated with rhGH and had attained final height from 2005 to 2013 in a single tertiary paediatric centre compared to (n= 21) heights/age matched healthy controls. By applying different models of DXA adjustment, our analysis revealed lower TB-BMC for bone area in males with CO-GHD and lower LS-BMAD SDS in females with CO-GHD compared to matched controls. In addition, subjects with CO-GHD had lower LM for height and higher FM for height compared to controls, and this was more pronounced in males than females (p=0.04). The time of onset and aetiology of CO-GHD have a larger influence on accrual of bone mass in these patients. These findings indicate that adolescents with CO-GHD have a low bone mass, despite prior long term rhGH replacement therapy. In chapter 5, we investigated bone health of subjects with CO-GHD at time of initial evaluation and retesting at final height. A total of 25 children (first time assessment group) undergoing GH stimulation tests for investigation of short stature (naive GHD-15, normal-10), and 11adolescents with CO-GHD (retesting group) undergoing biochemical re-evaluation at final height after withdrawal of rhGH therapy (persistent GHD-7, GH-sufficient-4) were recruited from Royal Hospital for Children between 2012-2013. By using further bone health assessment methods in addition to DXA (including p.QCT, mechanography, bone profiles and biomarkers), the bone density and body composition did not differ when we compared GHD to matched height but normal GH at initial evaluation and retesting. However, naive GHD had lower muscle force as assessed by mechanography compared to the normal. In addition, bone resorption biomarker CTX was significantly higher in naive GHD vs. normal and that was significantly correlated to PTH levels in both first time assessment and retesting groups. Our results suggest that muscle force and serum PTH may be important determinants of bone health in subjects with CO-GHD. Chapter 6 investigates lipids, adipokines (leptin- adiponectin- resistin) and glucose homeostasis and their relationship with bone and body composition in children and adolescents with CO-GHD at times of initial evaluation and retesting at final height (same population as chapter 5). Lipid profiles, adipokines and glucose homeostasis were not different between those with GHD and those who had normal GH levels across the groups of first time assessment and retesting. In the retesting group, those who were older at the time of diagnosis of CO-GHD with a shorter duration of rhGH therapy were more likely to have higher cholesterol(r=0.9, p<0.001), leptin (r=0.8, p<0.001), and lower osteoclacin (r=-0.7, p=0.01) at final height. Leptin levels correlated positively with osteocalcin at diagnosis (r=0.51, p=0.01) but inversely at retesting (r=-0.91, p<0.01). The conclusion was that the timing and duration of childhood rhGH therapy might influence adiposity parameters and bone metabolism in subjects with CO-GHD. In chapter 7 the study participants of chapter 5 were asked to complete either Short Form-36 (SF-36) or Adult Growth Hormone Deficiency Assessment (AGHDA) quality of life (QoL) questionnaires at the time of assessment of their GH axis. Our analysis showed that the overall QoL was not altered in children with naive GHD with a total score of SF-36 [93 (77, 96) naive GHD vs. 90 (84, 93) normal, P=0.56] (higher scores reflect better QoL). However, naive GHD had less energy and vitality scores compared with normal (75 (65, 100) vs. 95 (65,100) respectively, p=0.04), when the normal scored lower in the subscale of emotional well-being compared to those with naive GHD (78 (55, 84) vs. 90 (68, 96) respectively, p<0.001). In the retesting group, those with persistent GHD scored better in the AGHDA than GH sufficient (6 points (2, 8) vs. 9 points (7, 17) respectively, though not significant (p= 0.10) (higher scores reflect poorer QoL). Unexpectedly, subscale analysis showed that GH-sufficient subjects significantly lacked energy and complained of tiredness compared to those who were confirmed to have persistent GHD (5 points (3, 6) vs. 1 point (0, 1) respectively, p= 0.03). Further studies to validate QoL specific instruments in this population are needed with greater insight to elucidate factors that modify the relationship between GH status and QoL in children and adolescents. Chapter 8 was a prospective intervention, randomised controlled study of 14 subjects among the first time assessment group (GHD-10, normal-4) and five subjects with CO-GHD among retesting group (persistent GHD-4, GH-sufficent-1). Subjects were randomised into either an exercise intervention group (EX) (25 jumps off 25 cm platform step/three days/week for six months) or a control, in addition to rhGH being prescribed. The results of this study were limited by the small sample size and poor compliance. Therefore, there were insufficient data to recommend the use of weight bearing exercise in the absence of rhGH in children and adolescents with CO-GHD. Further studies with adequate sample size that can more rigorously exam the optimal exercise interventions are needed. Chapter 9 discusses the main findings of each chapter in this thesis and outlines potential limitations of the thesis methodology, and some important and interesting areas for future research in children and adolescents with CO-GHD.

Childhood obesity is becoming increasingly prevalent in the UK and globally. Over the last 10 years, there has been a rise in prevalence of risk factors for health and a decline in physical activity. Obesity is major health risk factor for a number of other chronic diseases, some of which are prevalent in children. Regular physical activity is associated with reduced adiposity, healthier metabolic status lower risk factors of diabetes and CHD and enhanced bone mineral accrual and protection against osteoporosis. Recent literature suggests that children may not be meeting the recommended daily guideline for physical activity of 60 min per day (Riddoch et al., 2007), while others suggest this guideline is insufficient to protect against risk factors in children. Assessment of programmes promoting physical activity, with robust health related outcome measures are therefore warranted Initially, sixty-one children were recruited for a 9-week exploratory trial. The trial assessed the effect of a structured high impact exercise (STEX) and a lifestyle intervention (PASS). Changes in dual-energy X-ray absorptiometry (DXA) derived body composition and bone mineral were compared to age matched controls (CaNT). The STEX intervention resulted in an additional mean increase in total body BMC of 63.3 g (P= 0.019) and an additional increase of 0.011 g.cm-2 (P= 0.018) for BMD over changes observed in controls. Neither intervention stimulated significant increases in BMC or BMD at the femoral neck or lumbar spine (P > 0.05) compared with the controls. No significant changes were found in fat mass index (P > 0.05), lean mass index (P > 0.05) or percent body fat (p = 0.09) in any groups. Structured impact exercise promoted significant and clinically relevant increases in bone measures, without significant changes to body composition. The exploratory finding therefore supported the need for a larger, definitive randomised trial to confirm the results. Following this, a large cohort of Liverpool school children (n=152) was recruited for cross-sectional analysis. Measures included 3-day physical activity using a uniaxial accelerometer, maturity status, cardia-respiratory fitness and skin-fold measurements in addition to body composition, bone mineral content and density. Analysis of variance was used to uncover any sex differences, partial correlation analysis was performed to investigate relationships between health-related variables and physical activity, with maturity offset as the controlling variable. Regression analysis was performed to find the best predictor of BMC and BMD (primary outcome variable), using LM, FM, Mass, and maturity offset as predictor variables. The results showed that children participated in the recommended amount of activity. However, body fat measures indicated that the children fell between the 85th-95% percentile for overweight. Further more BMD status of both sexes also fell below reference values. The dose-response relationship was highlighted as children who participated in < 60 mln.oay" recommendation were less physically fit (P=0.001) and fatter (P < 0.001) than children achieving this guideline. Children participating in over >90 min.day" had significantly lower percent body fat (P=0.005) and fat mass (P=0.04) than children who participated in < 60 min.day" and significantly lower percent body fat (P=0.02)than all children who participated in < 90 min.day". The findings highlight the importance of the high volume ( > 90 rnin.day") and high-intensity physical activity (over 10 min.day") as a precursor to low body fat and high bone mineral in children. The one hundred and fifty-two children from the baseline cohort were allocated to 1 of 4 groups over a 12 month period. Three groups received a different physical activity intervention; a high-intensity programme ('HIPA'), a skill development programme ('FMS') or a lifestyle-based programme ('PASS'). The 'HIPA' and 'FMS' groups participated in an after-school club (2x60 min.week"), the 'PASS' group attended weekly classroom sessions (1 x week) delivered by a lifestyle coach during the school day. The control group ('CaNT') received health information. All baseline measures were repeated at 9 and 12 months (during and after) intervention. All interventions minimised fat mass accumulation, with the 'HIPA' intervention being most effective (P=0.03), implying that the high-intensity nature of the activity sessions was more effective at minimising body fat accumulation. The greatest magnitude of change in femoral neck BMC (P < 0.001) and BMD (P < 0.001) and cardiorespiratory fitness (P=0.023) was also reported by the 'HIPA' group which is likely to be attributable to the intensity of the weight-bearing activities included in the 'HIPA' programme. The findings suggested that the 'HIPA' intervention was most beneficial for health outcomes, but all interventions had significant effect on increasing time spent in physical activity. The studies within this thesis have provided a unique insight in to the current bone health status, body composition and physical activity of 9-11 year old Liverpool school children. Further data were also generated on the effect of different physical activity interventions on bone health, body composition and physical activity. The findings from this thesis conclude that a proportion of 9- 11 year old children were overweight despite meeting physical activity recommendations of 60 min.day". The high-intensity physical activity intervention had the most beneficial impact on bone health, body composition and cardio-respiratory fitness when compared to the controls. The quantity of physical activity and the time spent in high intensity activity warrants further investigation to quantify an optimal dose.

Low childhood physical activity levels, and high paediatric overweight and obesity levels, carry a considerable burden to health including cardiometabolic disease, low fitness, and reduced psychosocial well-being. Numerous school- based physical activity interventions have been conducted with varied success. This thesis therefore aimed to develop and investigate the effectiveness of the Children's Health, Activity and Nutrition: Get Educated! (CHANGE!) project, which was a school-based curriculum intervention to promote healthy lifestyles using an educational focus on physical activity and healthy eating. The purpose of the formative study (Study 1) was to elicit subjective views of children, their parents, and teachers about physical activity to inform the design of the CHANGE! intervention programme. Analyses revealed that families have a powerful and important role in promoting health-enhancing behaviours. Involvement of parents and the whole family is a strategy that could be significant to ~ncrease children's physical activity levels. There is large variation in the cut-points used to define moderate physical activity (MPA), vigorous physical activity (VPA) and sedentary time, which impacts on accurate estimation of physical activity levels. The purpose of Study 2 was to test a field-based protocol using intermittent activities representative of children's physical activity behaviours, to generate behaviourally valid, population-specific cut-points for sedentary behaviour, MPA and VPA. These cut-points were subsequently applied to CHANGE! to investigate changes in physical activity (Study 3). The CHANGE! intervention resulted in positive changes to body size and VPA outcomes after follow-up. The effects were strongest among those sociodemographic groups at greatest risk of poor health status. Further work is required to test the sustained effectiveness of this approach in the medium and long-term. Further, the development of an inexpensive and replicable field- based protocol to generate behaviourally valid and population-specific accelerometer cut-points may improve classification of physical activity levels in children, which could enhance subsequent intervention and observational studies.

A mother's practice of feeding the family is viewed as risk behaviour in published health literature where the dominant research interest lies in its pathogenic potential in the aetiology of Child Obesity. Mothers’ 'participative knowledge' of their practice, which is their lived experience as known and given meaning by them, is absent from this literature. The aim of the thesis is to address this gap in knowledge and reflect upon its significance for health promotion. The exploration of mothers’ family feeding practices was conducted by means of a Co-operative Inquiry (Heron, 1996) which I adapted as a community participatory research study with a core group of 13 volunteer mothers. This community of mothers from a former mining community in the NW of England became in time my co-researchers in the investigation of what feeding the family entailed and meant for them. There are two phases of the inquiry. In Phase 1, methods were developed to enable mothers to collect data and to engage in reflection and dialogue so as to describe and explain their practice. In Phase 2, the Inquiry process was directed towards empowering mothers to engage in transformative experiential learning. Findings at the end of Phase 1 highlighted that the mothers’ routine practices often exposed their children to risk factors linked to childhood obesity. It also identified that their reality and lived experience systematically exposed mothers to social injustice that had the potential to undermine their health. At the end of Phase 2 however, new insights into the potential meaning of their practice, led the mothers to make changes in family feeding; and to transform an alienating environment into an empowering experience of true community. The author reflects and discusses the inquiry and its findings by drawing upon theories of knowledge, practice and health; and empirical evidence of risk factors in health inequalities. This study extends the body of knowledge about family feeding with insights into the participative reality of mothers’ practice. The Author recommends health research should embrace new theoretical frameworks for inquiry with mothers to develop a more socially just knowledge of their practice that can empower both mothers and community.

Smoking is the greatest avoidable cause of premature death in Britain today, particularly among the poorest people in society. Most smokers take up the habit during childhood, and the age at which children begin to smoke is falling over time. Although patterns of regular smoking are often established during the teenage years, rates of experimentation with cigarettes peak during preadolescence. Despite this, in the UK there has been little longitudinal research into the process of smoking uptake during preadolescence, and this research fills that significant gap. The Liverpool Longitudinal Study of Smoking (LLSS) is a unique longitudinal study that has tracked a cohort of approximately 250 children during their early years at primary school. This thesis continues and develops the LLSS by exploring the cohort's experiences of smoking during preadolescence in order to understand how children's early smoking careers develop between the ages of 9 and 11. Baseline quantitative and qualitative data collected at age 9 (in 1999) were compared with data collected at age 10 (in 2000) and at age 11 (in 2001) in order to identify key elements of change. These data were analysed longitudinally using a multiple case study approach that identified the individual trajectories of five children during preadolescence. A cross-case comparative method was then used to identify and explain the relationship between views, intentions and behaviour, and how these were shaped by the social context in which the children lived. The themes that emerged from the case studies were then explored and developed in the context of data generated by the whole cohort. Statistical analysis revealed that smoking by best friends, fathers and brothers, together with knowing someone with a smoking-related disease, at age 9 predicted smoking by age 11. The discourses that the children used to talk about smoking uptake emphasised the role of parents at age 9, but by age 11 the cohort suggested that friends were the key influence on smoking onset. Each year, anxiety about being bullied into smoking by older children also emerged as a key concern for this age group. In addition, the analysis revealed that preadolescents appropriate adult discourses around the use of smoking as a coping strategy. The use of these discourses was patterned by socioeconomic status. Children who lived in deprived areas suggested that both adults and children might smoke to counter stress and to relieve boredom. However, some of the girls living in relatively affluent areas perceived that adults smoke to control their weight. The study also considered the implications of these discourses for differential rates of smoking uptake at primary school. A key finding of this phase of the LLSS is that preadolescents construct smoking as an adult behaviour, and therefore some children smoke in order to negotiate status in anticipation of the transition to adolescence and as a strategy of resistance to the exercise of adult power. The reduction of rates of smoking among children and young people is central to the government's tobacco control strategy, and this research has significant implications for the development of both interventions and policy.

No description available.

The number of babies that require care in the Neonatal Intensive Care Unit continues to rise in the UK and parents who have a baby who is born sick or prematurely find themselves adapting to this stressful and often unexpected event whilst also trying to establish their role as a new parent. With no current large British studies, this study explores the experiences of both mothers and fathers in the NICU in relation to adaptation and parental role development and how their experience changes over time. In total 76 parents were interviewed using semi structured interviews 7-10 days following the birth to capture their early experiences of the NICU and then again beyond 28 days to explore any changes in their views and feelings over time. Interviews were tape recorded, transcribed verbatim into the written word and imported into WINMAX PRO. Data analysis revealed nine major sections. These are preparation prior to birth, labour and delivery, first sight of infant, support from the partner, family, friends and other parents, support from and communication with staff, adaptation to the NICU experience, development of the parental role, changes with time and the experiences of fathers. Findings show differences in what mothers and fathers find stressful about their NICU experience, how they adapt to the birth of a sick or premature infant and in their development of the parental role. With the passage of time the events surrounding the birth became less significant as parents start to look to the future. Their role as a parent continued to develop with feelings that their baby needed and recognised them, but many parents felt that they were unable to influence what happened to their baby in the NICU. Recommendations are made for further research and for changes to NICU practice.

Breastfeeding is arguably considered the world as the ideal way to feed the baby and is characterized as a predictive factor for this health promotion, providing protection against morbidity and mortality. However, in some very limited situations, the Ministry of Health contraindication to breastfeeding. And in these situations it is believed to be essential to think of the mothers who had contraindicated breastfeeding and negative feelings that can come from this experience. Objective: understand the perception of nurses about the mothers who experience conditions that contraindicate breastfeeding and recognize the experience of caring for mothers who had the breastfeeding contraindicated. Methods: A descriptive and exploratory study with a qualitative approach. Attended nineteen nurses who work in rooming in two referral hospitals in Aracaju, SE. Data were analyzed using content analysis and based on the Theory of Symbolic Interaction. Results: Nurses noticed that mothers who have displayed against breastfeeding require more attention and care. They realized even when these mothers understand that not breastfeeding protects their babies have feelings of consciousness, conformity and acceptance, as well as sadness, frustration, fear, anguish, shame, embarrassment, guilt, and escape when they experience the conviviality of rooming with women who can breastfeed, and due to bandaging the breasts. It was found that the participants considered that it is important to protect the privacy of mothers who had contraindicated breastfeeding, as these are allocated in private environments. The bandaging the breasts remained widely used as a measure associated with pharmacological inhibition of lactation, though no longer recommended by the Ministry of Health. It was found that nurses prioritize orientation actions and they see the importance of the host to these mothers. Conclusion: Nurses demonstrated their perception of mothers contraindicated breastfeeding in rooming. The study demonstrated the need for concern with the provision of more skilled nursing care, and sensitively provide care, support and guidance, seeking to understand the uniqueness that each situation requires. In this context, the researcher's perspective was supported by the Theory of Symbolic Interactionism. / O aleitamento materno é indiscutivelmente considerado no mundo como a forma ideal para alimentar o bebê e caracteriza-se como fator preditivo para promoção da saúde deste, conferindo proteção contra a morbimortalidade. Entretanto, em algumas situações bem restritas, o Ministério da saúde contraindica a amamentação. E nessas situações acredita-se ser indispensável pensar nas mães que tiveram a amamentação contraindicada. Objetivos: compreender a percepção do enfermeiro acerca das mães que vivenciam condições que contraindicam a amamentação e reconhecer a experiência do cuidar de mães que tiveram a amamentação contraindicada. Método: Estudo descritivo, exploratório, com abordagem qualitativa. Participaram dezenove enfermeiras atuantes em alojamento conjunto, em duas maternidades de referência em Aracaju, SE. Os dados foram analisados por meio da análise de conteúdo e fundamentados pela Teoria do Interacionismo Simbólico. Resultados: As enfermeiras perceberam que mães que tem a amamentação contraindicada demandam maior atenção e cuidado. Perceberam ainda que quando essas mães compreendem que a não amamentação protege seus bebês, apresentam sentimentos de consciência, conformismo e aceitação, além de tristeza, frustração, medo, angústia, vergonha, constrangimento, culpa e fuga ao vivenciarem o convívio do alojamento conjunto com mulheres que podem amamentar, e devido ao enfaixamento das mamas. Verificou-se que as participantes consideraram que é importante para resguardar a privacidade das mães que tiveram o aleitamento materno contraindicado, que estas sejam alocadas em ambientes privativos. O enfaixamento das mamas permaneceu amplamente utilizado, como medida associada à inibição farmacológica da lactação, embora já não recomendado pelo Ministério da Saúde. Constatou-se que as enfermeiras priorizam ações de orientação e enxergam a importância do acolhimento a essas mães. Conclusão: Enfermeiros demonstraram a sua percepção acerca das mães contraindicadas a amamentar no alojamento conjunto. O estudo demonstrou a necessidade de preocupação com uma prestação de cuidados de enfermagem mais qualificada, e que com sensibilidade ofereça cuidados, apoio e orientação, buscando entender a singularidade que cada situação exige. Neste contexto, o olhar do pesquisador foi apoiado na Teoria do Interacionismo simbólico.

Orientador: Maria Cecília Marconi Pinheiro Lima / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-24T01:02:26Z (GMT). No. of bitstreams: 1 Lopes_TeresinhaSoaresPereira_D.pdf: 3237893 bytes, checksum: fc386b3eb452979148ab83c1e1d7d23e (MD5) Previous issue date: 2013 / Resumo: Apesar dos claros benefícios do aleitamento materno para a saúde do bebê e da mãe, as taxas de amamentação continuam abaixo das recomendadas por agências nacionais e internacionais. Objetivos: Delinear o perfil da amamentação, os hábitos bucais de sucção e as possíveis implicações que a prática do aleitamento materno pode desencadear nas características morfológicas e funcionais do sistema motor oral em crianças atendidas em um programa odontológico de atenção materno infantil. Método: Trata-se de um estudo observacional, transversal, com 252 crianças entre 30 a 48 meses de idade, de ambos os sexos. O projeto foi aprovado pelo Comitê de Ética em Pesquisa da UFPI (parecer nº CAAE 0039.0.045.000-10). A coleta de dados ocorreu por meio da aplicação de um questionário às mães e exame clínico das crianças. Para verificar associação entre as diferentes variáveis foi utilizado o teste qui-quadrado de Pearson, a odds ratio por meio da Regressão Logística (fatores associados à presença de hábitos de sucção) e razão de prevalência (respiradores orais e alterações oclusais), com seus intervalos de confiança de 95% para medir o efeito das variáveis relacionadas ao tempo de aleitamento materno. O nível de significância estatística estabelecido foi p<0,05. Resultados: Do total da amostra, 48,4% (n=122) das crianças mamaram no peito de forma exclusiva durante seis ou mais meses de idade; 27,4% apresentaram hábitos de sucção não nutritiva; 56,9% (n=143) padrão de respiração nasal e 59,9% (n=151) algum tipo de alteração oclusal, com oclusão normal em 40,1% (n=101). Como fator associado ao aparecimento dos hábitos de sucção não nutritiva, encontrou-se um menor tempo de aleitamento materno. As crianças que mamaram de forma exclusiva de 6 a 12 meses de idade têm 69% menos chances de ter hábitos de sucção deletérios, quando comparadas com as que mamaram até um mês. Houve associação estatisticamente significativa entre o uso da mamadeira (p<0,001) e a prática de hábitos bucais de sucção não nutritiva (p=0,009), com o aumento da prevalência de as crianças exibirem padrão respiratório predominantemente oral. Os tipos de - alterações oclusais observadas foram: sobressaliência 29,8% (n=75); sobremordida 24,6% (n=62); desvio da linha média 17,5% (n=44); mordida aberta anterior 9,5% (n=24); mordida cruzada anterior 3,6% (n=09); mordida cruzada posterior 3,6% (n=09). Não foi verificada diferença estatisticamente significativa (p>0,05) em relação ao tempo e ao tipo de aleitamento materno e desvios oclusais. Conclusões: A taxa de aleitamento exclusivo nas crianças de seis ou mais meses de idade mostrou-se acima da média nacional; a continuação do aleitamento materno após seis meses de idade exerceu influências positivas na diminuição de hábitos de sucção não nutritiva; o padrão respiratório predominantemente oral foi elevado; aleitamento materno exclusivo e aleitamento materno prolongados estão associados ao padrão respiratório nasal das crianças; houve associação estatisticamente significativa entre o uso de mamadeira e os hábitos bucais de sucção não nutritiva; o tempo e o tipo de aleitamento materno não estiveram associados aos diferentes tipos de alterações oclusais nas crianças / Abstract: Despite the clear benefits of breastfeeding for the health of the baby and the mother, breastfeeding rates remain below those recommended by national and international agencies. Objectives: To delineate the profile of breastfeeding, oral suction habits and the possible implications that breastfeeding may trigger on the morphological and functional characteristics of the oral motor system in children assisted in a dental program for maternal and child care. Method: This was an observational, cross-sectional study with 252 children aged between 30-48 months of age, from both sexes. The project was approved by the Ethics Committee of the UFPI (opinion No. CAAE 0039.0.045.000-10). The data were collected through the application of a questionnaire to mothers and clinical examination of children. To verify the association between the different variables, it was performed the Pearson's Chi-Square test, the odds ratio by Logistics Regression (factors associated with the presence of suction habits) and prevalence ratio (oral breathers and occlusal changes), with its confidence interval of 95% to measure the effect of variables related to breastfeeding duration. The level of statistical significance was set at p <0.05. Results: From the total sample, 48.4% (n = 122) of the children were breastfed in an exclusive way for six months or more of age, 27.4% presented non-nutritive sucking habits, 56.9% (n = 143) nasal breathing pattern and 59.9% (n = 151) some kind of occlusal alteration and normal occlusion in 40.1% (n = 101) as a factor associated with the onset of non-nutritive sucking habits, was found a minor duration of breastfeeding. Children who were breastfed in an exclusive way for 6 to 12 months of age are 69% less likely to have deleterious sucking habits when compared with those who were breastfed up to one month. There was a statistically significant association between the use of baby bottle (p <0.001) and the practice of oral habits of non-nutritive sucking (p = 0.009), with increased prevalence of children exhibit predominantly oral breathing pattern. The observed types of occlusal alterations were: overjet 29.8% (n = 75); overbite 24.6% (n = 62); midline deviation 17.5% (n = 44), anterior open bite 9.5 % (n = 24), anterior crossbite 3.6% (n = 09), posterior crossbite 3.6% (n = 09) It was not verified statistically significant difference (p> 0.05) in relation to the time and type of breastfeeding and occlusal deviations. Conclusions: The rate of exclusive breastfeeding in children of six or more months of age was shown itself above the national average; continued breastfeeding after six months of age exerted positive influences on the decrease of non-nutritive sucking habits, the predominantly oral breathing pattern was high exclusive breastfeeding and prolonged total breastfeeding are associated with the nasal breathing pattern of children. There was statistically significant association between baby bottle feeding and oral habits of non-nutritive sucking, time and type of breastfeeding were not associated with different types of occlusal alterations in children / Doutorado / Ciencias Biomedicas / Doutora em Ciências Médicas