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Speech development and infant feeding: possible implications/ Desenvolvimento da fala e alimentacao infantil: possiveis implicacoes.

INTRODUCTION

Feeding the child requires special attention from birth, since this is the basis for growth, development and maintenance of the vital state of the human being. In this context, should be followed what the World Health Organization (WHO) recommends, exclusive breastfeeding during the first six months of life. From this age, onwards, other foods and liquids are gradually introduced into the child's diet, and this transition should be carefully followed up by a professional [1].

Early weaning or unexercised sucking may culminate in the establishment of deleterious oral habits such as pacifier use, digital suction and oral breathing. These frequently demonstrate a relation to occlusal disarrangement, besides being able to justify changes in swallowing, breathing and speech functions [2].

Nowadays, compliance with minimum standards of diet quality is a challenge in many developing countries, especially in areas where family food security is restricted because it has not been given due importance [3]. The child in this situation runs the risk of not receiving the necessary food at the right age and not being fed frequently enough during the day or being exposed to food of inadequate quality.

In this way, there is concern not only with the nutritional aspect, but also regarding the way the food is offered, mainly in terms of consistency and texture. These are characteristics that will favor anatomical-functional changes of the infant, which, associated with neurological maturation, will allow the correct execution of neurovegetative functions, among them, the speech.

The use of the solid consistency during chewing stimulates the increase in the force that the orofacial muscles exerts on the teeth [4]. This will not only change the quality of mastication, but also the development of maxillary bones, dental arches and other hard structures (such as dental elements), minimizing the possibility of occlusion changes.

Oral health, also stimulated by masticatory action, has repercussions on speech production. Despite this, it can be affirmed that early dental losses may imply alterations in the articulatory pattern, as it allows the interposition of the tongue in the edentulous region, as a means of stabilizing the mandible. When loss occurs in the posterior region, there is no significant impairment in speech quality, whereas absence of anterior teeth favors omission and replacement of phonemes [5].

Muscle activity per cycle is also relatively low for soft foods, which implies a lower total muscular activity required for the formation of food bolus [6]. Thus, the predominant consumption of pasty or soft consistency as the basis in a diet, results in a decrease in the workload or load of the muscle tissue, which may lead to a narrowing of the maxillary arch, especially in the areas of masticatory muscle insertion.

Another study [2] showed that, in individuals who prefer humidified foods and soft consistency, the decrease in the participation of orofacial musculature is a probable etiological or contributing factor to the existence of dental crowding, alteration of the orofacial musculature tonicity, oral breathing, tongue interposition between dental arches during rest and in the performance of stomatognathic functions.

Not only the muscles that move the mandible have an increased activity in the presence of foods with a more rigid consistency, but also the tongue, because when it participates in the swallowing of hard foods, there is an increase in amplitude and variation in lingual activity, particularly in the Posterior region [7].

The soft tissues and the mandible, which are required to perform the efficient masticatory function during administration of most solid consistency food, are basically the same structures that will modify the sound originated from the larynx by variations of the oral cavity spaces, produced by the speech. Failures in the biomechanics of this mechanism can affect the production of specific phonemes [8]. Therefore, inadequate stimulation resulting from the use of predominantly soft foods may lead to the hypofunctionality of the tongue, which will lead to a compromise in the production of sounds such as /r/, /s/, /z/, /t/, /d/, /n/, /l/, as well as lowering of the tonicity of the orbicularis muscles of the lips, which would justify the incorrect articulation of phonemes such as /p/, /b/ and /m/.

Within this context, it can be observed that infant feeding favors the adequate growth and development of the child, contributing to maturation of several functions, including speech. The aim of this study, therefore, is to identify the association between eating habits and speech development in pre-school children.

METHODS

The study complied with Resolution 196/96 of the National Health Council, being previously analyzed and approved by the Research Ethics Committee of the Federal University of Pernambuco-Opinion no. 12907 of 12/04/2012, CAAE no 00642012.3.0000.5208.

A case-control study was carried out in 15 children of public educational units in the city, from April to July 2012, with children between the ages of 3 and 5 and 11 months of age, of both sexes. Children with congenital malformations, hearing impairment, as well as those with a physical or mental disability that could compromise speech development were excluded. Thus, the final sample consisted of 273 individuals, of whom 173 were males and 100 were females.

For those who agreed to participate, the data collection was preceded by the science and signing of the Term of Free and Informed Consent (TCLE) by the parents or guardians. They then, responded to a structured interview, whose objective was to collect the most reliable information about socioeconomic characteristics, such as family income, maternal age and schooling, and eating habits of the research participants.

Soon after the interview, the collecting was started with the children, which were submitted to the speech-language evaluation, whose main objective was to detect speech changes. For that, we used the phonological evaluation protocol contained in the ABFW, Children's Language Test, indicated for children aged from two to 12 years, phonetically balanced for Brazilian Portuguese [9].

Phonemic production was recorded using a digital voice recorder (Sony ICD-PX312) for later analysis of speech and allocation of the children in case or control situations. Were denominated cases, children of both sexes who presented, in the naming and imitation tests [9], omissions, substitutions, additions or distortions of phonemes related to functionality and associated with the motor aspect of speech production, therefore the alteration should be identified by both tests for the speech pattern to be considered incorrect. The control group were constituted by children of the same age group, of both sexes, who did not present such speech alterations. It should be noted that phonemic productions associated with regionalism, socioeconomic status and chronology of acquisition of children's phonemes, were not considered pathological.

It was also observed aspects of the phono-articulatory structures (tonus, posture and mobility) of lips, tongue and cheeks, of the stomatognathic functions of mastication and swallowing, besides the examination of the elements and dental occlusion, based on the MBGR10 protocol.

To define the type of feeding as to consistency, questions were asked regarding the eating habits of the children in the interview applied to parents or guardians. The elaboration of the questionnaire used in the interview was based on previous studies [11,12] which presented classification of the type of feeding. In this way, questions and answer options were defined regarding the type of food consistency and later characterization.

The analysis of data collected with the parents or guardians and children was performed on the statistical program STATA / SE 9.0 and Microsoft Excel 2007 software. For this, protocol and questionnaire data were pre-coded and transported to a pre-established database with double entry and the application of Validate-verification of typing reliability.

To investigate the measure of association between speech and eating habits, odds ratios were calculated as well as the 95% confidence interval and p value.

To enable data tabulation and statistical treatment of aspects related to eating habits, the subjects' diet was classified as hard (solid), soft (solid-soft, pasty or liquid) and balanced (balanced in terms of consistency offered). The analysis of the menu of the collection sites qualified as balanced the food consistency offered by them.

RESULTS

The study had a final sample composed of 273 individuals (136 cases and 137 controls) of both sexes, whose age ranged from 3 years to 5 years and 11 months.

Table 1 shows characteristics of the sample and data concerning the female genitor. In general, the sample presented unfavorable socioeconomic level, represented by the short time of maternal schooling and family income equal to or slightly above a minimum wage. It can be seen that most of the individuals belong to the male sex and have an age range varying from 3 years to 4 years and 11 months. Only the gender variable presented a statistically significant association with speech disorders (OR = 1.79; IC 95% = 1,03-3,10; p = 0,038).

The data in Table 2 expose the sample characteristics associated with nutritive and non-nutritive sucking habits. Most of the children in the two study groups did breastfeed and used artifacts such as baby bottle and pacifier at some point in their lives, but none of the variables studied showed a statistically significant association with speech changes.

Table 3 presents data referring to the oromiofunctional disorders of the children participating in the research. It was observed that both, the usual posture alterations of the phono-articulatory organs and the performance of other stomatognathic functions demonstrated a statistically significant association with the outcome studied. Thus, for example, the resting lip position (OR = 2,82; IC 95% = 1,57-5,07; p<0,001) and the performance of the masticatory function (OR = 2,22; IC95% = 1,05-4,76; p=0,045) presented a significant relation with the presence of speech alterations.

Table 4 shows the food consistency data used by the research subjects. It was observed that the hard consistency was the most used for both groups, but it did not show a statistically significant association with the speech changes (OR = 1,31; IC95% = 0,55-3,14; p=0,257).

The same happened regarding food consistency, in which there was no statistically significant association between the consistency of the foods consumed and alteration in the stomatognathic system.

DISCUSSION

The results of this research revealed a statistically significant association between males and presence of speech disorders. This finding corroborates a study [13] that estimated the prevalence of speech disorders in 7,881 students from primary schools, finding a higher prevalence of this manifestation in the male sex (16.7%), in comparison to the female (12.7%) in a significant way, but there was not justifications for such finding. In the present research, however, this result should be relativized due to the difference in the number of subjects for the sex variable, in which there were a number of male participants considerably superior to the female.

In a review study of articles related to the topic [14], it was observed that the risk factors most frequently cited by the authors for the development of speech disorders include being male, without mentioning an apparent explanation.

A cross-sectional study [15] developed with 1,810 students from the public school system in Rio Grande do Sul, which aimed to verify the prevalence of speech disorders in schoolchildren and associated factors, identified a similar proportion of speech disorders between the sexes.

The present study did not reveal a statistically significant association between age and speech alterations, but found that most individuals included in the group of cases belonged to the three-year age group. Some omissions, substitutions and phonemic distortions are typical of the acquisition of Brazilian Portuguese, and should not be considered as pathological emissions, depending on the age group. Therefore, it is necessary to verify what process is taking place and to observe if this linguistic behavior is still admissible for the age of the individual. However, when the child reaches five years old, the infant must be able to emit the entire phonetic repertoire of his vernacular language [9].

The study [15] found evidence of speech alterations in all subjects of the sample of their research with less than five years, justifying that the development of linguistic consciousness derives from the development and biological maturation acquired in the constant exchanges with the environment or context, thereby the child is in continuous process of acquiring new knowledge of gradual complexity.

The socioeconomic conditions of the studied population were represented by social and demographic indicators, such as family income, age and maternal schooling, which referred to the less favored social class. These indicators did not show a significant association with the presence of speech alterations, since the sample studied was relatively homogeneous, respecting the selection conditions of the individuals for case-control studies. However, another study [16] stated that the precarious conditions of life that several Brazilian families are exposed by, such as the ones that made up this sample, justify less constructive and stimulating environments for child development, which may compromise, along with the motivational aspects, the cognitive and linguistic developments of the child.

Speech alterations in the present study did not show a statistically significant association with maternal schooling, which differed from another study [15] in which parents' schooling was an important factor associated with this type of disorder. However, in this study, there was a discrepancy regarding the parents' level of education, which was directly proportional to the children's best speech performance.

Length of stay in the educational unit was another variable that did not have a significant association with the dependent variable, nor was it possible to identify studies that analyzed the relationship between the two. When evaluating the menu that the institutions provided to the children, it was possible to detect variation in consistency, flavor, temperature and form of food administration, being classified as a balanced diet. Thus, even individuals enrolled in the one-shift regime were exposed to a balanced diet, but it should be considered that full-time individuals should demonstrate a greater daily exposure to such food variation, since as a low-income population, it is difficult to maintain the standard of feeding varied in the daily routine of the home meals.

Another aspect that should be taken into account is the importance of the permanence of the children in the Early Childhood Centers, where they have the opportunity to develop values related to social, psychological and biological aspects, contributing to the healthy growth and development of the individuals.

The family history of speech disorder was also referred to by another research [14] as a factor frequently cited in the articles that composed its article review, due to the probable genetic component of organic alterations, but this variable did not demonstrate a significant association with the outcome in the present research.

A systematic study of the literature [17] found an association between these variables. In their reports, they stated that speech changes are common in a family group, suggesting that genetic factors are involved, but their etiology at the molecular level is not well understood. They also referred to studies in which mutations in the FOXP2 gene were discovered in members of the same family, who presented changes in the emission of speech sounds.

Bibliographical research [18] related to Pediatric areas, Dentistry and Speech-Language Pathology, through Medline, found that natural breastfeeding favors the correct development of the stomatognathic system concerning mobility, strength and posture aspects of the structures that compose it, Therefore it should benefit the correct articulation of the phonemes, since such structures are directly involved in the process of speech sounds production, which was not perceptible in the casuistry of this research. It should be emphasized that the present research used only audio recording of children's speech and not video footage, which could provide more precise analysis regarding the possible compensations performed for phoneme production, through the compromise of some phonoarticulatory organ.

The same study also reported that, on the contrary, early weaning, because it does not satisfy the instinctive sucking desire of children, may favor the establishment of habits such as bottle feeding, digital sucking and pacifiers, which compromise the healthy development of the stomatognathic system and may be, for example, the etiology of malocclusion, which negatively impacts the structures involved in the speech production process. In this research, the habits of nutritive and non-nutritive sucking did not present a significant association with speech alterations.

In a cross-sectional study [19] conducted in southern Brazil with a random sample of 100 mothers with children up to 12 months of age, it was identified that 55% of the subjects did not breastfeed for the period determined by the WHO, at least one of the aforementioned habits.

The use of the bottle favors the work of a reduced group of orofacial muscles, favoring the activity of the buccinator muscles and the orbicularis of the mouth, compromising the correct development of the craniofacial complex and, thus, being associated with alterations in the articulation of speech sounds [18]. But in the present study it did not demonstrate a significant association with the outcome evaluated.

The use of pacifiers and digital suction, considered non-nutritive sucking habits, can also be consequences of early weaning and also contribute to the appearance of alterations in phono-articulatory organs. In this context, a cross-sectional study [20] nested in a birth cohort in Pelotas, southern Brazil, with 359 children, found that these behaviors demonstrate a relationship with occlusal derangement. In the present study, there was no statistically significant association between these aspects and speech disorders.

On the other hand, the oromiofunctional alterations revealed a significant statistical association with the dependent variable, mainly in relation to the posture of the phono-articulatory organs. This finding agrees with a study [2] that, when performing a speech and language assessment in children of a municipal daycare center in Bauru, Sao Paulo, highlighted the impairment in muscle tone as the main factor associated with speech disorders. However, it is worth mentioning that the posture of structures with the lips can be influenced by aspects such as orbicularis muscle tone of the mouth, characterizing some dependence between the two aspects.

Another research [8] of the control case type involving 40 individuals, whose objective was to investigate the effect of the decrease in saliva production on the mandibular movement during the execution of the chewing and speech functions, found that the habitual incorrect posture of the lips and tongue could compromise the adequate contact of the phono-articulatory organs during the execution of such functions, which can generate distortion of the produced sound, compromising the production of speech sounds.

In the present study, the usual tongue interposition between the dental arches demonstrated a statistically significant association with the outcome. However, it is verified that the confidence interval for the risk measure is beyond expectations, which may suggest insufficient sample size for the analysis of this relation. Therefore, it is possible to infer that if the sample consisted of a greater number of children, this association would be maintained, with a reduction in risk.

The reduced tongue functionality also showed a significant relationship with the presence of speech disorders. This finding corroborates the research mentioned above, since they observed that such impairment impedes the correct emission of phonemes that require greater amplitude and precision of tongue movements, such as /r/, /s/, /z/, /t/, /d/, /n/, /l/.

Another variable that demonstrated a significant association with the outcome was the change in dental occlusion, corroborating with the research [21] that aimed to evaluate 152 children with signs and symptoms of disorder in the temporomandibular joint and observed that disorders in the relationship between maxilla and mandible can exert a direct influence on the posture of the organs recruited for speech production. In addition, in the same study, they evaluated the movement of phono-articulatory organs during the production of phonemes, detecting distortions and previous lisping in the emission of phonemes /s/ and /z/ and inappropriate position of the tongue in phonemes /t/, /d/, /n/, /l/.

Still in relation to hard structures, another study [5], when conducting the dental and speech-language assessments of 50 adult individuals in the city of Bariri, Sao Paulo, stated that the integrity of teeth can affect the production of speech, since dental losses can imply in alterations in the articulatory pattern by permitting lingual interposition in the edentulous region as a means of stabilizing the mandible, going against the findings of this study. The posture assumed by the tongue, in situations like this, as previously mentioned, can negatively impact the production of the phonemes.

By directly verifying the relationship between the variables balanced food consistency and speech changes, no statistically significant association was identified. The difficulties in evaluating the food consistency, both for the information and memory bias of the subjects who answered the questionnaire, and for the lack of validation of the instrument of data collect, and speech, due to the age of the population group studied, could compromise the understanding of the interaction of the two variables.

However, understanding speech as a function that depends on the correct growth and development of the stomatognathic system, requiring harmonious relationship between the phono-articulatory organs, to make the specific modifications of the sound originating from the larynx, one can admit that the factors that collaborate for the adequate maturation of the orofacial structures, indirectly, favor correct phonemic production.

In this sense, a case-control study [4] developed in the city of Rio de Janeiro, involving 60 children with and without dental crowding, pointed to a favoring of the stomatognathic system when solid consistency is used during mastication, since it promotes adequate orofacial musculature tone and craniofacial complex growth, thus reducing the occurrence of malocclusions and, thus, of speech disorders. The mastication assumes, in evolutionary terms, the role of the suction in relation to the stimulation of the correct biodynamics of the stomatognathic system.

Also noteworthy is the study [22] developed in Bangladesh, using data from 1,728 children whose ages ranged from six to 23 months, obtained from nationally representative data from the Bangladesh Demographic 2007 and Health Survey. The authors found that diversification of infant feeding, mainly in terms of consistency and texture, favored anatomofunctional changes inherent to craniofacial growth, which, together with neurological maturation, allow the correct execution of neurovegetative functions, among them, speech.

The influence of predominantly soft feeding on the development of the maxillary bones was tested in their study with rodents [6], being observed a decrease of the work or load of the muscular tissue, being able to lead to a narrowing of the maxillary arch and hypotonia of the masticatory muscles. When considering such impacts on the stomatognathic system of a human, it is perceived that there may be compromise in the emission of speech sounds.

Therefore, specific characteristics associated with males, oromiofunctional alterations related to posture of the phono-articulatory organs and dental malocclusion had a greater influence on the speech changes in preschool children.

This finding is essential for the development of prevention/intervention strategies by health and education managers and professionals who directly or indirectly aid children of pre-school age, to minimize this aggravation impact on the region's health and economy.

Thus, the importance of correct nutrition, with variation of texture and consistency, must transpose the nutritional sphere and be understood as a facilitator of the development of the child in a global way, thus avoiding the installation of future disorders.

CONCLUSION

Food consistency showed a significant association with variables that influence the correct dynamics of the stomatognathic system, in terms of phono-articulatory organs and function performance. From this, it can be inferred that food and speech patterns constitute a point of intersection in children's health.

It is important to note the importance of feeding interference and oral habits in the appearance of malocclusion and its relation with speech disorders, making it possible to understand the interaction of factors that are indirectly related to the outcome studied.

doi: 10.1590/1982-0216201618611516

Received on: August 22, 2016 Accepted on: December 05, 2016

Conflito de interesses: inexistente

ACKNOWLEDGMENTS

The CNPq for the support and for costing the research.

REFERENCES

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[3.] Kabir I, Khanam M, Agho KE, Mihrshahi S, Dibley MJ, Roy SK. Determinants of inappropriate complementary feeding practices in infant and young children in Bangladesh: secondary data analysis of Demographic Health Survey 2007. Mater Child Nutr. 2012;8:11-27.

[4.] Pena CR, Pereira MMB, Bianchni EMG. Caracteristicas do tipo de alimentacao e da fala de criancas com e sem apinhamento dentario. Rev. CEFAC.2008;10(1):58-67.

[5.] Jorge TM, BassiAKZ, Yarid SD, Silva HM, SilvaRPR, Caldana ML et al.Relacao entre perdas dentarias e queixas de mastigacao, degluticao e fala em individuos adultos. Rev. CEFAC. 2009;11(3):391-7.

[6.] Tanaka E, Sano R, Kawai N, Langenbach GE, Brugman P, Tanne Ket al. Effect of Food Consistency on the Degree of Mineralization in the Rat Mandible. Anna Biomed Eng. 2007;35(9):1617-21.

[7.] Sugita K, Inoue M, Taniguchi H, Ootaki S, Igarashi A, Yamada Y.Effects of food consistency on tongue pressure during swallowing. J Oral Biosci. 2006;42(4):278-85.

[8.] Gomes SG, Del Bel Cury AA, Garcia, RCMR. Effect of hyposalivation on mastication and mandibular movements during speech. Braz Oral Res. 2011;4:351-6.

[9.] Wertzner HF. ABFW: teste de linguagem infantil nas areas de fonologia, vocabulario, fluencia e pragmatic [CD-ROM].Barueri(SP): Pro-Fono, 2004.

[10.] Genaro KF, Berretin-Felix G, Rehder MIBC, Marchesan, IQ. Avaliacao Miofuncional Orofacial Protocolo MBGR. Rev. CEFAC. 2009;11(2):237-55.

[11.] Silveira LDBR, Goldenberg M. Habitos e preferencias alimentares de criancas com tres a cinco anos de idade. Rev. CEFAC.2001;3(1): 37-44.

[12.] Pena CR, Pereira MMB, Bianchini EMG. Caracteristicas do tipo de alimentacao e da fala de criancas com e sem apinhamento dentario. Rev. CEFAC. 2008;10(1):58-67.

[13.] Karbasil SA, Fallah R, GolestanM. The prevalence of speech disorder in primary school students in yazd-iran. Acta Med Iran.2011;49:33-7.

[14.] Wankoff LS.Warning Signs in the Development of Speech, Language, and Communication:When to Refer to a Speech-Language Pathologist. J Child Adoles Psychiatr Nurs. 2011;24:175-84.

[15.] Goulart BNG, Chiari BM. Prevalencia de desordens de fala em escolares e fatores associados. Rev Saude Publica.2007;41(5):726-31.

[16.] Soares CB, Salvetti MG, Avila LK. Opiniao de escolares e educadores sobre saude: o ponto de vista da escola publica de uma regiao periferica do Municipio de Sao Paulo. Cad Saude Publica. 2003;19(4):1153-61.

[17.] Kang C, Drayna D. Genetics of speech and language disorders. Annu Ver Genomics and Hum Genet.2011;12:145-64.

[18.] Neiva FCB, Cattoni DM, Ramos JLA, Issler H. Desmame precoce: implicacoes para o desenvolvimento motor-oral. J Pediatr. 2003;79(1):7-12.

[19.] Moimaz SA, Zina LG, Saliba NA, Saliba O. Association between breast-feeding practices and sucking habits: A crosssectional study of children in their first year of life. J Indian Soc Pedod Prev Dent. 2008;22(2):102-6.

[20.] Peres KG, Barros AJD, Peres MA, Victora CG. Effects of breastfeeding and sucking habits on malocclusion in a birth cohort study. Rev Saude Publica. 2007;41(3):343-50.

[21.] Pizolato RA, Fernandes FSF, Gaviao MBD. Speech evaluation in children with temporomandibular disorders. J Appl Oral Sci. 2011;19(5):493-9.

[22.] Senarath U, Godakandage SSP, Jayawickrama S, Siriwardena I, Dibley MJ. Determinants of inappropriate complementary feeding practices in young chlindren in Sri Lanka: secondary data analysis of Demographic and Health Survey 2006-2007. Matern Child Nutr.2012;8(supl 1):11-27.

Victor Costa Alves Medeiros Vieira (1) Claudia Marina Tavares de Araujo (1) Silvia Regina Jamelli (1) (1) Universidade Federal de Pernambuco (UFPE), Recife, Pernambuco, Brasil. Source of Assistance: CNPq

Mailing address: Victor Costa Alves Medeiros Vieira Rua Tertuliano Castro, no 969, apto 503. Bessa, Joao Pessoa, Paraiba, Brasil CEP: 50035-170 E-mail: victorflacosta@yahoo.com.br
Table 1. Relationship between speech alteration,
sample characterization and mother data. Recife, 2012

                         SPEECH IMPAIRMENT

Variables                YES          NO

                       N     %      N     %
Age

3 years old            51   47,2   59    35,8
4 years old            38   35,2   72    43,6
5 years old            19   17,6   34    20,6

Gender

Male                   77   71,3   96    58,2
Female                 31   28,7   69    41,8

Shift in the
educational unit

One shift              46   42,6   85    51,5
Full time              62   57,4   80    48,5

Family Income

< 1 minimum wage       38   35,2   43    26,2
[less than or equal    70   64,8   121   73,8
  to] 1 minimum wage

Maternal age

[greater than or       2    1,9    11    6,8
  equal to]
  20 years old
21 to 24 years old     20   18,7   28    17,3
25 to 29 years old     43   40,2   53    32,7
[less than or equal    42   39.3   70    43,2
  to] 30 years old

Maternal schooling

[less than or          66   62,3   96    60,0
  equal to] 8
  years of study
> 8 years of study     40   37,7   64    40,0

Family with speech
impairment

Yes                    23   21,3   22    13,6
No                     85   78,7   140   86,4

                             SPEECH IMPAIRMENT

Variables               OR        IC       p * value

Age

3 years old            1,64   0,92--2,93     0,166
4 years old            0,94   0,45--1,98
5 years old            1,00       --

Gender

Male                   1,00       --         0,038
Female                 1,79   1,03--3,10

Shift in the
educational unit

One shift              0,70   0,42--1,17     0,187
Full time              1,00       --

Family Income

< 1 minimum wage       1,53   0,87--2,67     0,148
[less than or equal    1,00       --
  to] 1 minimum wage

Maternal age

[greater than or       0,30   0,04--1,56     0,208
  equal to]
  20 years old
21 to 24 years old     0,88   0,41--1,88
25 to 29 years old     1,35   0,75--2,45
[less than or equal    1,00       --
  to] 30 years old

Maternal schooling

[less than or          1,10   0,64--1,88     0,809
  equal to] 8
  years of study
> 8 years of study     1,00       --

Family with speech
impairment

Yes                    1,72   0,86--3,44     0,134
No                     1,00       --

(*) Chi-square Test

Table 2. Relationship between speech alteration and habits
of nutritive and non-nutritive sucking among the participant
children. Recife, 2012

                 CHANGES IN THE SPEECH

Variables             YES           NO

                 N     %      N     %
Breast-feeding

No               11   10,3   20    12,2
Yes              96   89,7   144   87,8

Breastfeeding
  period

0-3 months       33   34,4   44    30,8
4-6 months       15   15,6   19    13,3
> 6 months       48   50,0   80    55,9

Baby bottle
Yes              79   73,8   119   72,1
No               28   26,2   49    27,9

Bottle feeding
  period

Currently        39   50,0   59    50,0
[less than or    36   46,2   47    39,8
  equal to]
  6 months
< 6 months       3    3,8    12    10,2

Digital
  suction

Yes              11   10,2   13    7,9
No               97   89,8   152   92,1

Pacifier
  suction

Yes              62   57,9   79    47,9
No               45   42,1   86    52,1

                      CHANGES IN THE SPEECH

Variables          OR          IC        p * value

Breast-feeding

No                0,82     0,35--1,91      0,773
Yes               1,00         --

Breastfeeding
  period

0-3 months        1,25     0,67--2,32      0,660
4-6 months        1,32     0,57--3,02
> 6 months        1,00         --

Baby bottle
Yes               1,16     0,65--2,08      0,865
No                1,00         --

Bottle feeding
  period

Currently         2,64     0,63--12,69     0,235
[less than or     3,06     0,72--14,87
  equal to]
  6 months
< 6 months        1,00         --

Digital
  suction

Yes               1,33     0,53--3,31      0,660
No                1,00         --

Pacifier
  suction

Yes               1,50     0,89--2,52      0,134
No                1,00         --

(*) Chi-square Test

Table 3. Relationship between speech disorder and oromiofunctional
characteristics of the participating children. Recife, 2012

                       CHANGES IN THE SPEECH

Variables                   YES            NO

                       N     %      n       %

Posture of lips
in mastication

Usually open           23   21,5   22     13,6
Open at times          46   43,0   59     36,4
Sealed                 38   35,5   81     50,0

Oral escape of
  food in chewing

Present                31   29,2   28     17,3
Absent                 75   70,8   134    82,7

Lip position on
  swallowing

Usually open           20   18,7   19     12,0
Open at times          47   43,9   55     34,8
Sealed                 40   37,4   84     53,2

Tongue interposition
  in swallowing

Present                39   36,4   11      6,9
Absent                 68   63,6   148    93,1

Resting lip
  posture

Half open              44   40,7   31     19,6
Sealed                 64   59,3   127    80,4

Tongue
  Functionality

Reduced                57   52,8   44     27,8
Adequate               51   47,2   114    72,2

Resting tongue
  posture

Interposed             23   21,3    3      1,9
Adequate               46   42,6   124    78,5
In the mouth floor     39   36,1   31     19,6

Cheek mobility

Reduced                33   30,6   41     25,9
Adequate               75   69,4   117    74,1

Change in
  occlusion

Present                76   70,4   87     52,7
Absent                 32   29,6   78     47,3

Early loss of
  deciduous teeth

Present                9    8,4     9      5,5
Absent                 98   91,6   156    94,5

                           CHANGES IN THE SPEECH

Variables               OR         IC        p * value

Posture of lips
in mastication

Usually open           2,23    1,05--4,76      0,045
Open at times          1,66    0,93--2,98
Sealed                 1,00        --

Oral escape of
  food in chewing

Present                1,98    1,06--3,70      0,031
Absent                 1,00        --

Lip position on
  swallowing

Usually open           2,21    1,00--4,90      0,035
Open at times          1,79    1,01--3,20
Sealed                 1,00        --

Tongue interposition
  in swallowing

Present                7,72    3,55--17,11    < 0,001
Absent                 1,00        --

Resting lip
  posture

Half open              2,82    1,57--5,07     < 0,001
Sealed                 1,00        --

Tongue
  Functionality

Reduced                2,90    1,68--5,01     < 0,001
Adequate               1,00        --

Resting tongue
  posture

Interposed             20,67   5,52--91,08    < 0,001
Adequate               1,00        --
In the mouth floor     3,39    1,82--6,32

Cheek mobility

Reduced                1,26    0,70--2,24      0,494
Adequate               1,00        --

Change in
  occlusion

Present                2,13    1,24--3,68      0,005
Absent                 1,00        --

Early loss of
  deciduous teeth

Present                1,59    0,56--4,55      0,479
Absent                 1,00        --

(*) Chi-square Test

Table 4. Relationship between speech alteration
and food consistency. Recife, 2012

Food consistency     CHANGES IN THE SPEECH

                     YES          NO

                      N     %     N     %

Predominantly soft   22    20,4   47   28,5
Predominantly hard   75    69,4   99   60,0
Balanced             11    10,2   19   11,5

Food consistency       CHANGES IN THE SPEECH

                      OR        IC       p * value

Predominantly soft   0,81   0,30--2,19
Predominantly hard   1,31   0,55--3,14     0,257
Balanced             1,00       --

(*) Chi-square Test
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Article Details
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Title Annotation:Original articles
Author:Vieira, Victor Costa Alves Medeiros; de Araujo, Claudia Marina Tavares; Jamelli, Silvia Regina
Publication:Revista CEFAC: Atualizacao Cientifica em Fonoaudiologia e Educacao
Article Type:Ensayo
Date:Nov 1, 2016
Words:5770
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