Hi Dee,
I've not seen aspiration due to strong neck extension in breastfeeding 
infants.  I know that there's often a warning about this in literature, 
but I have not seen any experimental evidence that it's true.  Adults 
have difficulty swallowing with their heads extended, but our epiglottis 
and soft palate no longer touch as infants' do, and our larynx is lower 
in the neck than are infants'.

I of course observe the infant feeding in any position I recommend, to 
make sure it works.  I do carry a stethescope for cervical auscultation 
(listening to the coordination of swallowing and breathing over the 
throat area) for use if there are any signs of aspiration (increasing 
congestion during the feed, poorly timed vocal fold closure, etc). In 
most babies I've worked with, more head extension improves the 
coordination of swallowing and breathing!

I'd love to hear from anyone who has experimental data on this (perhaps 
observation during a videoflouroscopic swallowing study.  I know some 
institutions at least occasionally perform these with a little barium on 
the breast).  I'm always open to changing my practices if I'm incorrect!
Catherine Watson Genna, IBCLC  NYC

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