Clinical pediatrics in the Mexican immigrant community

Editor's note: Statements regarding beliefs, practices, and behaviors without citations have been included when such beliefs, practices, and behaviors have been regularly noted by the author and her colleagues practicing at a community health center, where over 95% of patients and/or their families are Mexican-American immigrants.

The US continues to be a country of immigrants. As of 2006, roughly 37.5 million immigrants (documented and undocumented) were living in the US, accounting for 12.5% of the total population. Of these, 30% were from Mexico.¹

A different culture of care

When asked, families may share that they are giving their child penicillin, either orally or injected, by an untrained relative, folk healer (cuarandero), or pharmacy owner.⁴ Some parents may also have medications sent by relatives in Mexico. Examples of these medications include:

– Quadriderm–A topical cream containing betamethasone, gentamicin, and clotrimazole. Parents may use this cream to treat rashes (including facial rash) on their infants or older children.

– Metamizole (dipyrone or neo-melubrina)–A non-steroidal anti-inflammatory drug (NSAID) available in Central and South America. This medication is not available in the US because of its association with agranulocytosis and aplastic anemia.⁶ One study examining the use of metamizole by Spanish-speaking families in a pediatric clinic found that 35% of those screened admitted to giving metamizole to their children. Of these, 25% had purchased the medication in the US.⁷ Parents from Mexico were also found to use metamizole more frequently than parents from other Spanish-speaking countries.⁷

There may also be variation in how these families use FDA-approved medications. Some parents, for example, may give their children approved acetaminophen or NSAIDs without knowing the proper dosage or frequency. This lack of understanding may be exacerbated by the fact that many over-the-counter medications have instructions written in English only (see Language barriers in primary care).

As an alternative, parents may turn to Mejoralito, a brand name of acetaminophen often used in Mexico. Mejoralito is available in a children's form (80 mg chewable tablets) and in an infant form equivalent to the infant drops sold in the US (80 mg/0.8 mL). It is essential that we clarify with families both the dosage and the frequency of acetaminophen or NSAIDs they are giving their children, to prevent overdosing.

Similarly, a number of these families may be unaware that the use of aspirin in infants and children 18 years and younger is contraindicated secondary to its association with Reye's syndrome. They may be more likely to give aspirin for pain and fever relief, or may give their children aspirin-containing medications, such as bismuth subsalicylate (in Kaopectate and Pepto-Bismol) or acetylsalicylic acid (in Alka-Seltzer).