The enigma of lambdoid positional molding

One hundred and twenty-one consecutive patients presenting to the Children's National Medical Center with lambdoid positional molding (LPM) were reviewed. Clinical features included unilateral occipital flattening and alopecia and forward displacement of the ipsilateral ear, forehead, and maxilla. Head tilt and tightness of the ipsilateral sternocleidomastoid muscle were common. An unexplained preponderance of LPM was found in males (74%) and on the right side (72%), both findings statistically significant (p < 0.001). Importantly, a variety of other abnormalities were seen with LPM: torticollis (41%), large head circumference (40), excess extra-axial cerebrospinal fluid (35), developmental delay (19), and other CNS abnormalities (20%). Systemic problems affecting the mobility were also common. Only 3 patients had craniosynostosis, and only 2 with LPM required surgery for severe cosmetic deformities. An apparent increase in the incidence of LPM was attributed to current recommendations to keep infants supine to decrease the risk of sudden infant death syndrome, overutilization of infant carriers similar to cradleboards of earlier cultures, and neonatal medical problems resulting in relative immobility. No evidence was found to support the concept that LPM causes compressive brain pathology; thus, surgical treatment is not required for such fears. Further, the sequelae of underlying CNS and systemic problems associated with LPM would not be corrected by opening unfused sutures, but could even be misinterpreted as complications of surgery.