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Letters to the Editor

Acknowledgements The authors would like to thank Dr Alexa Kidd, Clinical Geneticist, Canterbury Health Laboratories and Tauranga Hospital Paediatric and the IT departments for their assistance with this review.

References 1 Palmer EE, Peters GB, Mowat D. Chromosome microarray in Australia: a guide for paediatricians. J. Paediatr. Child Health 2012; 48: E59–67. 2 Howell KB, Kornberg AJ, Harvey AS et al. High resolution chromosomal microarray in undiagnosed neurological disorders. J. Paediatr. Child Health 2013; 49: 716–24. 3 Reiff M, Mueller R, Mulchandani S, Spinner NB, Pyeritz RE, Bernhardt BA. A qualitative study of healthcare providers’ perspectives on the implications of genome-wide testing in pediatric clinical practice. J. Genet. Couns. 2013. doi: 10.1007/s/10897-013-9653-8. 4 Reiff M, Ross K, Mulchandani S et al. Physicians’ perspectives on the uncertainties and implications of chromosomal microarray testing of children and families. Clin. Genet. 2013; 83: 23–30.

Dr Pion Das1 Dr David Jones2 1 Senior House Officer 2 Community Paediatrician Department of Paediatrics Tauranga Hospital Bay of Plenty District Health Board, Tauranga New Zealand

Dear Editor,

undermine breastfeeding promotion. Relevant cultural beliefs and attitudes of Lao people include the view that colostrum is harmful, that mothers should avoid some potentially beneficial foods in the post-partum period, and exposure to hot-ember beds can enervate and dehydrate mothers.4,5 Education of pregnant women and mothers regarding the importance of breastfeeding needs to be initiated before they become pregnant and reinforced during antenatal care and in the immediate post-partum period, with recent qualitative research providing some encouragement that these beliefs are amenable to change.5 Programmes that minimise the effect of operative delivery upon initiation of breastfeeding can also be implemented.6 The battle against electronic media is never likely to be won, making the challenge of improving breastfeeding initiation and maintenance all the more important.

References 1 Phoutthakeo P, Otsuka K, Chiaki I et al. Cross-border promotion of formula milk in Lao People’s Democratic Republic. J. Paediatr. Child Health 2014; 50: 51–6. 2 Edmond K, Zandoh C, Quigley MA et al. Delayed breastfeeding initiation increases risk of neonatal mortality. Pediatrics 2006; 117: 380–6. 3 Moore ER, Anderson GC, Bergman N et al. Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database Syst. Rev. 2012; (5): CD003519. 4 Barennes H, Simmala C, Odermatt P et al. Postpartum traditions and nutrition practices among urban Lao women and their infants in Vientiane, Lao PDR. Eur. J. Clin. Nutr. 2009; 63: 323–31. 5 Holmes W, Hoy D, Lockley A et al. Influences on maternal and child nutrition in the highlands of the northern Lao PDR. Asia Pac. J. Clin. Nutr. 2007; 16: 537–45. 6 Hung KJ, Berg O. Early skin-to-skin after cesarean to improve breastfeeding. MCN Am. J. Matern. Child Nurs. 2011; 36: 318–24.

CROSS-BORDER PROMOTION OF FORMULA MILK IN LAO PEOPLE’S DEMOCRATIC REPUBLIC AND OPPORTUNITIES FOR BREASTFEEDING PROMOTION Phoutthakeo et al. are to be applauded for studying breastfeeding influences in Lao People’s Democratic Republic (PDR) and drawing attention to factors affecting the decision to persist with breastfeeding in a country that has high infant mortality rates.1 Although they have focused upon the negative influences of cross-border media advertising from Thailand, over which health practitioners have little influence, they have also confirmed that initiation of breastfeeding in the first hour after delivery, a factor known from other studies to be important for breastfeeding initiation and for child survival, is one of the significant influences upon exclusive breastfeeding in this population.2,3 They also identified the negative effect upon breastfeeding of operative delivery.1 Encroachment of electronic media upon societies in transition is probably inevitable. As important as these external influences are, the real challenge for health professionals in Lao PDR and elsewhere in South East Asia is dealing with the interaction of traditional practices and beliefs and social change, which Conflict of interest: None.

Professor David A Forbes Paediatrics & Child Health University of Western Australia Perth, Western Australia Australia

Dear Editor, SPINAL MUSCULAR ATROPHY-1 AND GASTROSTOMY While reading the review of spinal muscular atrophy (SMA)-1 management of Australian children in this journal,1 I was surprised that no children had been managed with a gastrostomy. From my own experience of three children with SMA-1 managed as a general paediatrician in metropolitan Melbourne, a gastrostomy was performed in two cases. The feedback from the parents about the impact it had on the management of their child was extremely positive. The first case was a male infant diagnosed at 7 weeks of age. He required nasogastric (NG) feeds from 2.5 months of age and Conflict of interest: None.

Journal of Paediatrics and Child Health 50 (2014) 573–576 © 2014 The Authors Journal of Paediatrics and Child Health © 2014 Paediatrics and Child Health Division (Royal Australasian College of Physicians)

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Cross-border promotion of formula milk in Lao People's Democratic Republic and opportunities for breastfeeding promotion.

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