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.
This is a preview of subscription content, access via your institution.
Buy single article
Instant access to the full article PDF.
Price excludes VAT (USA)
Tax calculation will be finalised during checkout.
We would like to gratefully acknowledge Drs. Margarita Kay, Arthur Rubel, Kaja Finkler, and Peter Guarnaccia for their comments regarding folk illness interview questions. Any errors or omissions are our own responsibility.
To estimate the community prevalence of recognition and belief in Caída de la Mollera as an illness, we used the number of people who were approached to participate in the study, whether or not they believed in caídaas the denominator. Thus, the community prevalence for belief in caída was: 97.5 % (39/40) in Guatemala, 85 % (40/47) in Mexico, and 82 % (41/50) in Texas.
Although our set of questions was balanced to include both positive and negative questions about caída de la mollera, the proportion of positive items in our answer sets was low (<26 %. Table 2), but not significantly different across the three samples (Chi Square p = 0.21). Additional analyses were performed to check the stability of the results. First, estimates of cultural knowledge scores were compared using match and covariance methods and found to be highly correlated (0.78 Guatemala, 0.71 Mexico, and 0.65 Texas), suggesting low response bias, especially at the Latin American sites. Second, analyses were repeated with a larger proportion of positive items by randomly omitting half of the negative themes, leaving 85 of the original 132 questions, and increasing the proportion of positive items to 41 %. The covariance estimates of cultural knowledge obtained from the full 132 item and the 85 item subset were strongly correlated: 0.97 Guatemala, 0.91 Mexico, and 0.99 Texas. Classification of answers changed on 2 % of answers, principally from “–” to either “yes” or “no.” Thus, results indicate that the results appear to be accurate and stable.
Pachter LM, Bernstein B, Osorio A. Clinical implications of a folk illness: empacho in mainland Puerto Ricans. Med Anthropol. 1992;13(4):285–99.
Kay MA. Fallen fontanelle: culture bound or cross cultural? Med Anthropol Q. 1993;15(2):137–56.
de Zoysa I, et al. Perceptions of childhood diarrhea and its treatment in rural Zimbabwe. Soc Sci Med. 1984;19(7):727–34.
Lozoff B, Kamath K, Feldman R. Infection and disease in South Indian families: beliefs about childhood diarrhea. Hum Organiz. 1975;34(4):353–8.
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.
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.
Clark M. Health in the Mexican-American culture: a community study. Berkeley, CA: Univ of California Press; 1959.
Kiev A. Curanderismo: Mexican-American folk psychiatry. New York: The Free Press; 1968.
Martinez C, Martin HW. Folk diseases among urban Mexican-Americans. J Am Med Assoc. 1966;196(2):161–4.
Neighbors KA. Mexican-American folk diseases. Western Folk. 1969;28(4):249–59.
Rivera G. Hispanic folk medicine utilization in urban Colorado. Sociol Soc Res. 1988;72(3):237–41.
Rivera G, Wanderer JJ. Curanderismo and childhood illnesses. Soc Sci J. 1986;23(3):361–72.
Rubel AJ. Across the tracks: Mexican-Americans in a Texas City. Austin: University of Texas Press; 1966.
Rubel AJ. The study of Latino folk illnesses. Med Anthropol. 1993;15(2):209–13.
Ruiz R. Combating a cultural myth: La caída de la mollera. R I Med. 1994;77(3):79–80.
Trotter RT. Remedios caseros: Mexican American home remedies and community health problems. Soc Sci Med Part B Med Anthropol. 1981;15(2):107–14.
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.
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.
Rubel AJ. Concepts of disease in Mexican-American culture. Am Anthropol. 1960;62(5):795–815.
Trotter RT. Community morbidity patterns and Mexican American Folk Illnesses: a comparative methodology. Med Anthropol. 1983;7(1):33–44.
Hudelson PM. ORS and the treatment of childhood diarrhea in Managua, Nicaragua. Soc Sci Med. 1993;37(1):97–103.
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.
Thompson J. Cultural aspects of treating Mexican patients. Clin Rev. 2002;12(5):56–62.
Brodman K, et al. The Cornell Medical Index. J Am Med Assoc. 1949;140(6):530.
Batchelder WH, Romney AK. Test theory without an answer key. Psychometrika. 1988;53(1):71–92.
Romney AK, Weller SC, Batchelder WH. Culture as consensus: a theory of culture and informant accuracy. Am Anthropol. 1986;88(2):313–38.
Weller SC. Cultural consensus theory: applications and frequently asked questions. Field Methods. 2007;19(4):339–68.
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.
Kiesler J, Ricer R. The abnormal fontanel. Am Fam Physician. 2003;67(12):2547–53.
Young J. Clinical pediatrics in the Mexican immigrant community. Contemp Pediatr. 2009;26(4):58–64.
King CK, et al. Managing acute gastroenteritis among children. MMWR. 2003;52(16):1–16.
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.
Kliegman R, et al., editors. Nelson textbook of pediatrics. 19th ed. Philadelphia, PA: Elsevier Saunders; 2011.
Herman E, Bentley M. Rapid assessment procedures, RAP: to improve the household management of diarrhea. Boston, MA: International Nutrition Foundation for Developing Countries; 1993.
Darby SB. Pre- and perinatal care of hispanic families: implications for Nurses. Nurs Women’s Health. 2007;11(2):160–9.
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.
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.
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.
This project was funded by National Science Foundation Grant #BNS-9204555 to S. Weller.
Conflict of interest
The authors have no conflicts of interest relevant to this article to disclose.
The authors have no financial relationships relevant to this article to disclose.
Rights and permissions
About this article
Cite this article
Pachter, L.M., Weller, S.C., Baer, R.D. et al. Culture and Dehydration: A Comparative Study of Caída de la Mollera (Fallen Fontanel) in Three Latino Populations. J Immigrant Minority Health 18, 1066–1075 (2016). https://doi.org/10.1007/s10903-015-0259-0
- Folk illness