Question 1: What remote lactation consulting techniques have you piloted/used? Rojjanasrirat: My colleagues and I piloted the use of in-home real-time videoconferencing (VC) in a research setting, 1 to determine the feasibility of using it to provide breastfeeding support to motherinfant dyads and to assess the reliability of the LATCH breastfeeding assessment tool. The in-home videoconferencing equipment included a small computer-attached camera, point-to-point encrypted videoconferencing software, a desktop or laptop computer with a minimum bandwidth of 384 kbps, external speakers, headsets, and microphones. 2 Sanders: The Texas Women, Infants and Children (WIC) Program uses video technology for IBCLC lactation consultations. WIC is a US Department of Agriculture supplemental food and nutrition, breastfeeding promotion, and support program. Our target population is low-to middle-income women who are either pregnant, breastfeeding, or postpartum, and infants and children to age 5. Texas can be geographically challenging. We have large urban areas with heavy traffic congestion, and vast, remote rural areas. Transportation is a major deterrent to residents of these areas accessing professional lactation care. WIC is a federally funded program with limited resources; we needed a low-cost solution that was convenient, inviting, and effective. Video conferencing was selected as the technology to provide distance IBCLC lactation care.Our IBCLC is located in a centrally located breastfeeding support center. The local WIC clinics are located in areas that are typically geographically close to the mothers' homes. Our clients visit their local WIC offices for the consult. The mothers are never left alone during the consult. They are assisted by a remote site assistant under the direction of the IBCLC via webcam. The remote site assistant can be a peer counselor, nutritionist, or dietitian; they help the mother with positioning and operates the camera for more diagnostic viewing.

BackgroundThe World Health Organization International Code of Marketing of Breast-Milk Substitutes (WHO Code) aims to protect and promote breastfeeding. Japan ratified the WHO Code in 1994, but most hospitals in Japan continue to receive free supplies of infant formula and distribute discharge packs to new mothers provided by infant formula companies. The aim of this study was to explore the knowledge and attitudes of pediatricians and obstetricians in Japan to the WHO Code.MethodsA self-completion questionnaire was sent to 132 pediatricians in the 131 NICUs which belonged to the Neonatal Network of Japan, and to 96 chief obstetricians in the general hospitals in the Kanto area of Japan, in 2004.ResultsResponses were received from 68% of pediatricians and 64% of obstetricians. Sixty-six percent of pediatricians agreed that "Breastmilk is the best", compared to only 13% of obstetricians. Likewise, pediatricians were more likely to be familiar with the WHO Code (51%) than obstetricians (18%).ConclusionIn Japan, pediatricians and obstetricians, in general, have low levels of support for breastfeeding and low levels of familiarity with the WHO Code. To increase the breastfeeding rates in Japan, both pediatricians and obstetricians need increased knowledge about current infant feeding practices and increased awareness of international policies to promote breastfeeding.