Caida de mollera-Sunken Fontanelle


Overview


Frontal_fontanel.png
Mollera caída, also known as caida de mollera or sunken/fallen fontanelle, is a Hispanic folk illness that affects infants. This illness describes when the crown or head of a baby’s skull is sunken or fallen. In the folk illness tradition, caida de mollera is explained to occur as a result of a bump or fall to the head of the infant, or due to quickly taking a baby away from the breast during breastfeeding. In addition to the fallen fontanelle, irritability, crying, and the inability to breastfeed are thought to be a result of pressing on the brain from the fallen fontanelle[1] [2] .

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An infant with a sunken fontanelle is treated with Oral Rehydration Therapy. Taken from rehydration.org

Western medicine describes the sunken fontanelle, or a sunken soft-spot, as a sign of dehydration caused by diarrhea, poor feeding, or other poor conditions for the infant[3] . The biomedical cause of the illness may be due to an illness that results in a ten percent loss of body weight or more in an infant. Some reasons for this loss in body weight include: bacterial or viral dysentery, meningitis, or sepsis [4] .

Hispanic folk medicine and Western medicine have distinct ways of understanding and treating an infant with a sunken fontanelle. The Hispanic folk tradition does not always address the issue of dehydration and this lack of treatment can lead to dangerous outcomes (ultimately death) for the health of the infant[5] .

Health Impact


Depending on the specific Hispanic culture, treatments for caida de mollera vary: however; common ways to treat this illness include prayer, pushing up on the roof of the infant’s mouth, holding the baby upside down, patting the baby's feet while upside down, or sucking on the crown of the infant’s crown of the head. In some traditions raw eggs or oil are rubbed on the fontanelle to bring it upwards and to take the pressue off of the brain[6] [7] . These treatments are usually not harmful when done gently, but these treatments and interpretations of the cause of the caida de mollera do not always treat the infant's dehydration. However, sometimes the treatment involves vigorous shaking of the infant [8] . This is particularly of concern as it can create subdural hematoma, a variation of battered child syndrome[9] .

In Western medicine, infants with this illness should receive fluid and electrolyte replacement. Oral hydration is needed, and IV rehydration may be necessary in severe cases of dehydration [10] . Some medical practitioners have reported difficulty with treating Hispanic patients with caida de mollera as a result of an understanding of the illness that differs from the biomedical understanding. For example, in some context parents of infants with caida de mollera rely on folk treatments and in other contexts they prefer to focus on treating the infant for diarrhea or other symptoms with antibiotics as opposed to rehydration techniques[11] .

Medical Anthropology Research


Although caida de mollera is known as a Hispanic folk illness, the illness or symptoms of the fallen fontanelle have been recognized in many different cultural settings and times. Kay (1993) notes that fallen fontanelle can be known as all of the following terms: “siriasus, sitibundum, fontanellae collapsus, el apostema cálido del cerebro, Blatfallen, Blattschiessen, entzündung des Gehirns und der Gehirnhäute der Kleinen Kinder, coup de soleil, sorte de maladie causée par l'inflammation des membranes du cerveau, head-mould-shot, mollera caída, desmollerado, gual, split skull, sutt, nhova, kubabula, chipande, phogwana and dehydration” [12] . However, cultural interpretations of the symptoms of fallen fontanelle and culturally appropriate treatments vary depending on the cultural context[13] .

Anthropologists have studied the folk illness of caida de mollera for many years. Ethnohistorians and anthropologists are in disagreement about the origins of caida de mollera as an illness in Hispanic traditions. For example, George Foster argues that the cultural concept of the illness is Spanish in origin; however, others suggests that the origins are a syncretic mix of Spanish and native Aztec beliefs. Ortiz de Montellano argues that caida mollera is of pre-Columbian origins. Caida de mollera was not reported as an illness in infants in areas of South America heavily influence by Spaniards such Peru. However, caida mollera is widespread in Mexico and Guatemala and other Central American countries, suggesting that the native medical beliefs of Mesoamerica were likely to be the origins of the illness[14] .

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From Hurtado's (1979) study, an informant's drawing of caida mollera

Guatemalan doctor and anthropologist Juan Jose Hurtado Vega conducted an early study of mollera caida and the way the illness is cognized in Guatemala. He explains that mollera caida is perceived as a subcategory of “illnesses produced by a rupture in the equilibrium of the body”[15] . Other anthropological studies have shown that caida mollera is common in Mexico, Honduras, Nicaragua, other Central American countries, and the Southwestern United States. Explanatory models of illness are commonly used to identify how specific populations perceive of caida de mollera, the causes, symptoms, and the course of the illness.


Applied Research


Applied anthropologists hope to utilize an understanding of the folk illness and common treatments to help facilitate communication between patients and specific Hispanic communities to create public health interventions that can help promote the health of babies and ensure rehydration when infants suffer from caida de mollera.

In a study of caida de mollera amongst Mexican and Mexican-American migrant children, Baer and Bustillo (1998) interviewed families as well as practitioners to better understand interpretations of the illness and the ways in which the physiological symptoms of the illness are treated. The authors argue that, in order for doctors to help treat the illness, studies should focus on the way that the physiological symptoms are treated rather than the ways in which the symptoms of the causes are treated. This investigation was a step in helping to create a better understanding of folk understandings of the disease so biomedical doctors could better serve the health needs of the population[16] .

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Photograph taken from feminis.com

Clear understandings of the symptoms and folk treatments of caida de mollera can help practitioners differentiate child abuse from attempts to cure the folk illness. Some researchers have concluded that treatment of caida de molera is an improbable cause of shaken baby syndrome injuries [17] .

Lastly, children that have caida de la mollera are sometimes perceived by society as being neglected, and this results in maternal guilt, something that health care professionals do not recognize often[18] [19] . Anthropologists can help to address these issues by improving communication between patient and provider and by setting up public health interventions.



Further Readings


Baer, Roberta and Marta Bustillo. 1998. Caida de mollera among Children of Mexican Migrant Workers: Implications for the Study of Folk Illnesses. Medical Anthropology Quarterly, Vol. 12, No. 2, pp. 241-249.

Hansen, Karen. 1997. “Folk Remedies and Child Abuse: A Review with Emphasis on Caida de mollera and its Relationship to Shaken Baby Syndrome.

Ingham, J.M. 1970 On Mexican folk medicine. American Anthropologist. 72(1):76-87.

Kay, MA 1993 Fallen fontanelle: culture-bound or cross-cultural? Med Anthropol. Apr;15(2):137-56.

Kendall, C.; Foote, D.; Martorell, R. 1984 Ethnomedicine and oral rehydration therapy: a case study of ethnomedical investigation and program planning. Social science & medicine. 19(3):253-260.

Ortiz de Montellano, Bernard 1987 Caida de Mollera: Aztec Sources for a Mesoamerican Disease of Alleged Spanish Origin. Ethnohistory , Vol. 34, No. 4, pp. 381-399.


Other Resources


This web article directed at new mothers addresses beliefs about how to care for a baby's fontanelle, recognizing certain folk practices for treatment of a fallen fontanelle:
“Realidades acerca de la mollera” Feminis. <http://www.feminis.com/1280-realidades-acerca-de-la-mollera.html>.


References


  1. ^ Hurtado Vega, Juan Jose. 1979 La" Mollera Caida": Una Subcategoria Cognitiva de las Enfermedades Producidas por la Ruptura del Equilibrio Mecanico del Cuerpo. Boletín Bibliográfico de Antropología Americana (1973-1979). 41 (50):139 -148
  2. ^ Trotter, R. T. 1991 A Survey of Four Illnesses and their Relationship to Intracultural Variation in a Mexican-American Community. American Anthropologist 93(1):115-125.
  3. ^ Hoogesteger, Carl. 2008. “Caida de mollera” Hispanic Folk Illnesses. Creighton University. < http://altmed.creighton.edu/MexicanFolk/mollera_caida.htm>.
  4. ^ “Caida de la Mollera”<http://www.rice.edu/projects/HispanicHealth/Courses/mod7/caida.html>
  5. ^ Kendall, C.; Foote, D.; Martorell, R. 1984 Ethnomedicine and oral rehydration therapy: a case study of ethnomedical investigation and program planning. Social science & medicine. 19(3):253-260
  6. ^ Trotter, R. T. 1991 A Survey of Four Illnesses and their Relationship to Intracultural Variation in a Mexican-American Community. American Anthropologist 93(1):115-125.
  7. ^ Sandler, Alan and Vincent Haynes. 1978. Nonaccidental trauma and Medical Folk Belief: A Case of Cupping. Pediatrics. Vol 61. No. 6, pp 921-22.
  8. ^ Sandler, Alan and Vincent Haynes. 1978. Nonaccidental trauma and Medical Folk Belief: A Case of Cupping. Pediatrics. Vol 61. No. 6, pp 921-22.
  9. ^ Guarnaschelli, J., Lee, J., and Pitts, F.W. 1972. “Fallen Fontanelle"(Caida de mollera).” The Journal of the American Medical Association. Vol 222, Issue 12. P 1545
  10. ^ Kendall, C.; Foote, D.; Martorell, R. 1984 Ethnomedicine and oral rehydration therapy: a case study of ethnomedical investigation and program planning. Social science & medicine. 19(3):253-260
  11. ^ Hudelson, P.M. 1993. ORS and the treatment of childhood diarrhea in Managua, Nicaragua. Social science & medicine. 37 (1): 97-103
  12. ^ Kay, MA 1993 Fallen fontanelle: culture-bound or cross-cultural? Med Anthropol. Apr;15(2):137-56.
  13. ^ Kay, MA 1993 Fallen fontanelle: culture-bound or cross-cultural? Med Anthropol. Apr;15(2):137-56.
  14. ^ Kay, MA 1993 Fallen fontanelle: culture-bound or cross-cultural? Med Anthropol. Apr;15(2):137-56.
  15. ^ Hurtado Vega, Juan Jose. 1979 La" Mollera Caida": Una Subcategoria Cognitiva de las Enfermedades Producidas por la Ruptura del Equilibrio Mecanico del Cuerpo. Boletín Bibliográfico de Antropología Americana (1973-1979). 41 (50):139 -148
  16. ^ Baer, Roberta and Marta Bustillo. 1998. Caida de mollera among Children of Mexican Migrant Workers: Implications for the Study of Folk Illnesses. Medical Anthropology Quarterly, Vol. 12, No. 2, pp. 241-249.
  17. ^ Hansen, Karen. 1997. “Folk Remedies and Child Abuse: A Review with Emphasis on Caida de mollera and its Relationship to Shaken Baby Syndrome.
  18. ^ “Caida de la Mollera”
    http://www.rice.edu/projects/HispanicHealth/Courses/mod7/caida.html
  19. ^ Hansen, Karen. 1997. “Folk Remedies and Child Abuse: A Review with Emphasis on Caida de mollera and its Relationship to Shaken Baby Syndrome.
    17.^ “Caida de la Mollera”