Well, Laura, I'm not an SLP but I am eternally curious and - always being one to check things out on myself, regardless of what books might say, I tried sticking out my tongue and moving it around with my neck flexed.. it was not comfortable at all. I tried doing so in a neutral position and it was much much easier and then I tried tipping my head back with my head in a "sniffing position" which made it super easy and then I hyperextended and that was not really different from the "sniffing position" with some extension. Neck extended in sniffing was the most relaxed position for my tongue. 

I find it easiest to swallow with my head tipped back. Always have.  So I decided to try drinking from a cup or a water bottle with my head in all these different positions and see how comfortable each is (and how much water dribbles out when my neck is flexed...lots). The most tension in the tongue was when my neck was flexed, with the most ease of swallowing when my neck was partially extended and head in sniffing position. Hyper-extension of the neck caused slightly greater tension in the tongue but not as bad as when flexed. I have, however, not had any CST and my neck is stiff today after cleaning quart perennials for a few hours. 

It is quite obvious with some babies that their neck has to have greater extension for them to breastfeed easily, in my observation. Worked with a mom not long ago whose infant has a more recessed chin than most, but not Pierre Robin. He had to be held super close with his neck well extended to allow him to get enough breast tissue in and his chin in contact with mom's breast. Once we got him into this position while side lying in bed, he actually smiled when he suckled and got a steady supply of milk.. so rewarding! He did really well in laid back position.

I also have noted how well extended baby's neck is when they self attach in the laid back position at birth and beyond (just google laid back breastfeeding - images).

I'm so lucky to be so easily entertained on a Sunday afternoon and I hope this sheds some light or maybe raises even more questions... 

Celina D, IBCLC, LLLL

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