Journal of Immigrant and Minority Health

, Volume 18, Issue 5, pp 1066–1075 | Cite as

Culture and Dehydration: A Comparative Study of Caída de la Mollera (Fallen Fontanel) in Three Latino Populations

  • Lee M. PachterEmail author
  • Susan C. Weller
  • Roberta D. Baer
  • Javier E. Garcia de Alba Garcia
  • Mark Glazer
  • Robert Trotter
  • Robert E. Klein
  • Eduardo Gonzalez
Original Paper


A sunken soft-spot or fontanel is a sign for dehydration in infants. Around the world, folk illnesses, such as caída de la mollera in some Latin American cultures, often incorporate this sign as a hallmark of illness, but may or may not incorporate re-hydration therapies in treatment strategies. This report describes a study of lay descriptions of causes, symptoms, and treatments for caída de la mollera in three diverse Latin American populations. A mixed-methods approach was used. Representative community-based samples were interviewed in rural Guatemala, Guadalajara, Mexico, and Edinburgh, Texas, with a 132 item questionnaire on the causes, susceptibility, symptoms, and therapies for caída de la mollera. Cultural consensus analysis was used to estimate community beliefs about caída. Interviews conducted in rural Guatemala (n = 60), urban Mexico (n = 62), and rural Texas on the Mexican border (n = 61) indicated consistency in thematic elements within and among these three diverse communities. The high degree of consistency in the illness explanatory models indicated shared beliefs about caída de la mollera in each of the communities and a core model shared across communities. However, an important aspect of the community beliefs was that rehydration therapies were not widely endorsed. The consistency in explanatory models in such diverse communities, as well as the high degree of recognition and experience with this illness, may facilitate communication between community members, and health care providers/public health intervention planners to increase use of rehydration therapies for caída de la mollera. Recommendations for culturally informed and respectful approaches to clinical communication are provided.


Ethnomedicine Folk illness Dehydration Hispanic Latino Culture 



This project was funded by National Science Foundation Grant #BNS-9204555 to S. Weller.

Compliance with Ethical Standards

Conflict of interest

The authors have no conflicts of interest relevant to this article to disclose.

Financial Disclosure

The authors have no financial relationships relevant to this article to disclose.


  1. 1.
  2. 2.
    Pachter LM, Bernstein B, Osorio A. Clinical implications of a folk illness: empacho in mainland Puerto Ricans. Med Anthropol. 1992;13(4):285–99.CrossRefPubMedGoogle Scholar
  3. 3.
    Kay MA. Fallen fontanelle: culture bound or cross cultural? Med Anthropol Q. 1993;15(2):137–56.CrossRefGoogle Scholar
  4. 4.
    de Zoysa I, et al. Perceptions of childhood diarrhea and its treatment in rural Zimbabwe. Soc Sci Med. 1984;19(7):727–34.CrossRefPubMedGoogle Scholar
  5. 5.
    Lozoff B, Kamath K, Feldman R. Infection and disease in South Indian families: beliefs about childhood diarrhea. Hum Organiz. 1975;34(4):353–8.CrossRefGoogle Scholar
  6. 6.
    Mull JD, Mull DS. Mothers’ concepts of childhood diarrhea in rural Pakistan: what ORT program planners should know. Soc Sci Med. 1988;27(1):53–67.CrossRefPubMedGoogle Scholar
  7. 7.
    Baer RD, Bustillo M. Caida de mollera among children of Mexican migrant workers: implications for the study of folk illnesses. Med Anthropol Q. 1998;12(2):241–9.CrossRefPubMedGoogle Scholar
  8. 8.
    Clark M. Health in the Mexican-American culture: a community study. Berkeley, CA: Univ of California Press; 1959.Google Scholar
  9. 9.
    Kiev A. Curanderismo: Mexican-American folk psychiatry. New York: The Free Press; 1968.Google Scholar
  10. 10.
    Martinez C, Martin HW. Folk diseases among urban Mexican-Americans. J Am Med Assoc. 1966;196(2):161–4.CrossRefGoogle Scholar
  11. 11.
    Neighbors KA. Mexican-American folk diseases. Western Folk. 1969;28(4):249–59.CrossRefGoogle Scholar
  12. 12.
    Rivera G. Hispanic folk medicine utilization in urban Colorado. Sociol Soc Res. 1988;72(3):237–41.Google Scholar
  13. 13.
    Rivera G, Wanderer JJ. Curanderismo and childhood illnesses. Soc Sci J. 1986;23(3):361–72.CrossRefGoogle Scholar
  14. 14.
    Rubel AJ. Across the tracks: Mexican-Americans in a Texas City. Austin: University of Texas Press; 1966.Google Scholar
  15. 15.
    Rubel AJ. The study of Latino folk illnesses. Med Anthropol. 1993;15(2):209–13.CrossRefPubMedGoogle Scholar
  16. 16.
    Ruiz R. Combating a cultural myth: La caída de la mollera. R I Med. 1994;77(3):79–80.PubMedGoogle Scholar
  17. 17.
    Trotter RT. Remedios caseros: Mexican American home remedies and community health problems. Soc Sci Med Part B Med Anthropol. 1981;15(2):107–14.CrossRefGoogle Scholar
  18. 18.
    Trotter RT. A survey of four illnesses and their relationship to intracultural variation in a Mexican-American community. Am Anthropol. 1991;93(1):115–25.CrossRefGoogle Scholar
  19. 19.
    Trotter RT, de Montellano BO, Logan MH. Fallen Fontanelle in the American Southwest: its origin, epidemiology, and possible organic causes. Med Anthropol. 1989;10(4):211–21.CrossRefPubMedGoogle Scholar
  20. 20.
    Rubel AJ. Concepts of disease in Mexican-American culture. Am Anthropol. 1960;62(5):795–815.CrossRefGoogle Scholar
  21. 21.
    Trotter RT. Community morbidity patterns and Mexican American Folk Illnesses: a comparative methodology. Med Anthropol. 1983;7(1):33–44.CrossRefPubMedGoogle Scholar
  22. 22.
    Hudelson PM. ORS and the treatment of childhood diarrhea in Managua, Nicaragua. Soc Sci Med. 1993;37(1):97–103.CrossRefPubMedGoogle Scholar
  23. 23.
    Kendall C, Foote D, Martorell R. Anthropology, communications, and health: the mass media and health practices program in Honduras. Hum Organ. 1983;42(4):353–60.CrossRefPubMedGoogle Scholar
  24. 24.
    Thompson J. Cultural aspects of treating Mexican patients. Clin Rev. 2002;12(5):56–62.Google Scholar
  25. 25.
    Brodman K, et al. The Cornell Medical Index. J Am Med Assoc. 1949;140(6):530.CrossRefPubMedGoogle Scholar
  26. 26.
    Batchelder WH, Romney AK. Test theory without an answer key. Psychometrika. 1988;53(1):71–92.CrossRefGoogle Scholar
  27. 27.
    Romney AK, Weller SC, Batchelder WH. Culture as consensus: a theory of culture and informant accuracy. Am Anthropol. 1986;88(2):313–38.CrossRefGoogle Scholar
  28. 28.
    Weller SC. Cultural consensus theory: applications and frequently asked questions. Field Methods. 2007;19(4):339–68.CrossRefGoogle Scholar
  29. 29.
    Weller SC, et al. Empacho in four Latino groups: a study of intra and inter-cultural variations in beliefs. Med Anthropol. 1993;15(2):109–36.CrossRefPubMedGoogle Scholar
  30. 30.
    Kiesler J, Ricer R. The abnormal fontanel. Am Fam Physician. 2003;67(12):2547–53.PubMedGoogle Scholar
  31. 31.
    Young J. Clinical pediatrics in the Mexican immigrant community. Contemp Pediatr. 2009;26(4):58–64.Google Scholar
  32. 32.
    King CK, et al. Managing acute gastroenteritis among children. MMWR. 2003;52(16):1–16.PubMedGoogle Scholar
  33. 33.
    Fernandez E, South-Paul J, Matheny S. Cultural, race, and ethnicity issues in health care. In: Taylor RB, et al., editors. Taylor’s diagnostic and therapeutic challenges. New York: Springer; 2005. p. 1–15.Google Scholar
  34. 34.
    Kliegman R, et al., editors. Nelson textbook of pediatrics. 19th ed. Philadelphia, PA: Elsevier Saunders; 2011.Google Scholar
  35. 35.
    Herman E, Bentley M. Rapid assessment procedures, RAP: to improve the household management of diarrhea. Boston, MA: International Nutrition Foundation for Developing Countries; 1993.Google Scholar
  36. 36.
    Darby SB. Pre- and perinatal care of hispanic families: implications for Nurses. Nurs Women’s Health. 2007;11(2):160–9.CrossRefGoogle Scholar
  37. 37.
    Pachter LM. Ethnic and cultural influences on child health and health services, in ambulatory pediatrics. Green M, Haggerty RJ, Weitzman ML, editors. Philadelphia: WB Saunders. p. 105–109; 1999.Google Scholar
  38. 38.
    Pachter LM, Cloutier MM, Bernstein BA. Ethnomedical (folk) remedies for childhood asthma in a mainland Puerto Rican community. Arch Pediatr Adolesc Med. 1995;149(9):982–8.CrossRefPubMedGoogle Scholar
  39. 39.
    Kleinman A, Eisenberg L, Good B. Culture, illness, and care: clinical lessons from anthropologic and cross-cultural research. Ann Intern Med. 1978;88:251–8.CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2015

Authors and Affiliations

  • Lee M. Pachter
    • 1
    • 2
    Email author
  • Susan C. Weller
    • 3
  • Roberta D. Baer
    • 4
  • Javier E. Garcia de Alba Garcia
    • 5
  • Mark Glazer
    • 6
  • Robert Trotter
    • 7
  • Robert E. Klein
    • 8
  • Eduardo Gonzalez
    • 9
  1. 1.Department of PediatricsDrexel University College of MedicinePhiladelphiaUSA
  2. 2.Center for the Urban Child, Section of General PediatricsSt. Christopher’s Hospital for ChildrenPhiladelphiaUSA
  3. 3.Department of Preventive Medicine and Community Health and Department of Family MedicineUniversity of Texas Medical BranchGalvestonUSA
  4. 4.Department of AnthropologyUniversity of South FloridaTampaUSA
  5. 5.UIESSIMSS, GuadalajaraGuadalajaraMexico
  6. 6.University of TexasEdinburgUSA
  7. 7.Department of AnthropologyNorthern Arizona UniversityFlagstaffUSA
  8. 8.Medical Entomology Research and Training UnitCenters for Disease Control and Prevention (CDC)Guatemala CityGuatemala
  9. 9.Department of Family MedicineUniversity of South Florida Morsani College of MedicineTampaUSA

Personalised recommendations