Monthly archives: June, 2018

Stretch Marks: What Are They and How to Get Rid of Them

Also known as striae, stretch marks are a form of scarring with an off-color hue that may or may not disappear over time. They may appear as stripes or narrow streaks on your skin and caused by a sudden stretch. They’re perfectly common and aren’t a serious cause for concern. Many women also suggest that using the best belly cream for pregnancy can help prevent them.

Anyone can have stretch marks. However, they tend to appear more on women than in men.

They may also be found on different parts of the body. Commonly affected areas include the hips, thighs, upper arms, breasts, lower back, and stomach.

Stretch marks occur when the skin has been stretch out too much that it can’t resume it’s normal form. This is often due to pregnancy, weight loss, rapid weight gain, or puberty. More than half of women get stretch marks during pregnancy.

Quick Facts on Stretch Marks

  • They form when skin is stretched too rapidly.
  • Pregnancy, weight gain or weight loss, and puberty can cause stretch marks.
  • There is currently no strong evidence showing the effectiveness of stretch mark treatments today.
  • They often disappear over time even without treatment.
  • They don’t pose any serious long-term health risks.

What Are Stretch Marks?

Stretch marks can also be known as striae, striae distensae, striae gravidarum, or striae atrophicans. They’re a form of scarring or disfiguring lesions.

The areas that are commonly affected by stretch marks:

  • Buttocks
  • Thighs
  • Hips
  • Abdomen
  • Breasts
  • Flank

Although not a physical threat, stretch marks can still cause problems with an individual’s self-image. For some, it can be a very problematic cosmetic issue that can affect daily living by causing anxiety and low self-esteem.

Common Signs and Symptoms

Before stretch marks appear, the skin may feel dry and itchy. You’ll then notice thin and pinkish lines emerging.

The marks will then appear wrinkly. The streaks may also show more obvious hues, such as purple, red, reddish-brown, or dark brown. The color of your stretch mark will largely depend on your own skin tone. After a while, the stretch marks may reduce visibility and flatten out. What’s left will be a pale or silvery scar that may or may not disappear completely. Some stretch marks can take years before they become less noticeable.

Common Causes and Risk Factors

Abrupt skin expansion or shrinkage is the most common cause for stretch marks. Other causes may also include:

  1. Pregnancy – 50-90% of pregnant women will have stretchmarks during or after the birth of their baby.
  2. Puberty – Because puberty can also cause rapid growth in girls and boys, you may also experience some skin stretching, which in turn leads to stretch marks.
  3. Rapid weight gain – If you gain weight in a short amount of time, your skin may have trouble adjusting to the fat that accumulates in your body. This expansion may stretch out your skin faster than it can handle, which also leads to stretch marks.
  4. Medical conditions – Cushing’s syndrome or Marfan syndrome may also cause stretch marks. This is because Marfan syndrome can reduce your skin’s natural elasticity, while Cushing’s syndrome causes you to gain weight rapidly due to an overproduction of a certain hormone.
  5. Using corticosteroids – The prolonged use of corticosteroid creams or lotions can decrease the elasticity of your skin. This is because it reduces the levels of collagen, which is responsible for strengthening and supporting your skin. More collagen means you’re less likely to get stretch marks on your body.

When stretch marks do appear, their appearance will start to change after some time. They either fade to white or something silvery. They’re also more likely to develop or get worse when your body contains a high level of cortisone, or if you use a cortisone-based cream. Your body naturally produces cortisone too because it converts the stress hormone, cortisol, which is produced by your adrenal glands.

Risk Factors

Evidence shows that the following factors may contribute to an individual’s likelihood of developing stretch marks:

  • Age
  • Chronic diseases
  • Family history
  • BMI (body mass index) before a woman’s pregnancy
  • Baby’s weight upon birth

Obese women, for example, may carry larger babies. Also, your age plays a crucial part in determining the amount of collagen in your skin.


Stretch marks can be easily diagnosed through a skin examination. The doctor will likely ask for your medical history and ask questions based on the signs and symptoms you experience. You’ll also be asked to share any existing medical conditions or medications you’ve used in the past or now.

In some rare cases, stretch marks may be a symptom of an underlying medical problem that requires immediate treatment or monitoring. But in general, they are not usually viewed as a threat and don’t lead to problems aside from possible aesthetic ones.

Treatment and Prevention

The treatment for stretch marks can be expensive and not always effective. The results vary from person to person.

Unless the cause of the scarring is an underlying condition, your insurer isn’t likely going to cover the expenses of the treatment. Because, more often than not, stretch marks are more of a cosmetic issue than a health one.

Creams, oils, and topical applications

Scientific data doesn’t show relevant evidence that applying any type of cream, oil, or lotion can help with preventing stretch marks. Although many mothers swear that using the best belly cream for pregnancy can do wonders to prevent or even heal stretch marks.


The best way to prevent stretch marks from appearing on your body is by doing the following:

  • Maintain a healthy weight
  • Avoid rapid weight loss or gain, like from yo-yo dieting
  • Eat a diet rich in vitamins and minerals.
  • Increase your intake of vitamins A and C to support skin health, as well as zinc and silicon
  • Control your weight gain during pregnancy
  • Drink plenty of water every day to avoid skin dehydration

Key Takeaways

Stretch marks generally pose no health risks to the individual. They do affect a person’s physical appearance, but they’re manageable and can usually be prevented depending on your self-care routine, diet, and family history. If you’d like to prevent stretch marks, consider getting the best belly cream for pregnancy and check the reviews from moms-to-be who have tried it themselves.

The Kindness of Remunerated Strangers

In March I was invited to a Summit, not as the word might imply on Middle-East peace but on the adoption of children, and more specifically the adoption of children in care. It was held at the Coram Museum on the site of the now demolished Foundling Hospital that sheltered children abandoned by their single mothers for nigh on 200 years. I was surprised to be invited, I am very out of touch with this world.

But I came away disappointed. I could see the last vestiges of Labour ‘deliverology’  in which the centre beats the local into doing better, which in this case means adopting more children into care. I worried about the certainty around language like ‘permanency’ that at best is easily misunderstood and at worst lacks any coherent meaning. And I was left craving not only evidence worthy of the massive intrusion into family life that adoption represents, but also some basic facts that help predict the potential of the intervention.

Since the Summit I have been ruminating, talking to experts and reading. This and the four blogs that follow summarise what I found.

The Kindness of Remunerated Strangers

1) From antiquity to the renaissance

In the not too distant past a child was passed through the torno (a hole in the wall) of a Spanish orphanage run by the order of Saint Vincent de Paul. Unlike many given up in this way, this child survived. We know this because his name, assigned to every child taken in by the order, was passed to his great grandchild, my friend, Kintxo Ochotorena y de Paúl (an accent placed above the ‘u’ of Paul gives Spanish identity to the French saint). Since antiquity, abandoned children were referred to as being ‘exposed’ in the sense that the family brought attention to the deserted child so they would be taken up by a family or institution. From this descriptor comes another Spanish name, Expósito, as inherited by Numancia defender Unai Expósito and the Baltimore Orioles catcher Luis Expósito.

With this in mind, when I left the Coram Summit I walked across the road to the Skoob bookstore and with luck found a second hand version of John Boswell’s classic history The Kindness of Strangers. I looked for a paragraph that I remembered from my training. It connects our parochial discussions about adoption to two millennia of tragedy:

“Parents abandoned their offspring in desperation when they were unable to support them, due to poverty or disaster; in shame, when they were unwilling to keep them because of their physical condition or ancestry (e.g. illegitimate or incestuous); in self-interest or the interest of another child, when inheritance or domestic resources would be compromised by another mouth; in hope, when they believed that someone of greater means or higher standing might find them and bring them up in better circumstance; in resignation, when a child was of unwelcome gender or ominous auspices; or in callousness, if they simply could not be bothered with childhood.”

The production line of abandonment has remained constant but the processing has evolved. Some of society’s responses, for example of oblation -adopting children into christianity- or servitude and indenture are now rare. Survival is now taken for granted. Most children entering foundling hospitals in the Middle-ages died within a few years of admission, an outcome possibly only marginally worse than had they been reared at home.

State regulation of the transaction has evolved slowly. There were never many sanctions against sharing children beyond the birth family. It was a necessity and commonplace. Between 10 and 30 per cent of children were in some way adopted by a stranger’s family, in all likelihood during antiquity and almost certainly in late 18th Century urban Europe. Societal ethics of tolerance or mild regulation were gradually codified by the church. As private, philanthropic provision became more common, the state became the ringmaster.

Fostering is a relatively modern addition to the story. The name comes from the Norse foū, meaning to feed or to support. It was codified by the Visigoths in present day Germany referring to children supported in a household who had no legal relation to the householder. The code set fees for the first three years of placement, after which the child would pay for him or herself from wages or would move on into servitude. I suppose today we would classify the idea under payment by results.

Remuneration, however, has not been the reserve of fostering. All forms of exposure of children involve some form of legal and/or financial transaction. I suspect the real kindness of strangers continues below the gaze of church or state in the informal non-exposed arrangements of families who seek neither legal protection nor compensation.

A major development has been the switch from all children to poor children. From antiquity to the Renaissance any child, whatever the means of the family, could be exposed, subject to oblation or even passed into servitude.  Birth produced a ball bouncing long on a roulette wheel before it found a resting point in one of many pockets whose  value was measured in terms of social mobility.  We remember the wolf that suckled Romulus and Remus, grandchildren of the King of Alba Longa, but not so much the farming family that took them in. (Indeed the myth allows us to ignore the working class prostitute who most likely provided the breast from which the children fed). In an early Viking saga referred to by Boswell a German Earl leaves the child he fathered with his sister in a forest to be watched over by servants. The child is fostered -not adopted- by a childless Danish noble and eventually becomes the King of Denmark, a rare example of a state being founded on the three pillars of incest, abandonment and high quality foster care.

Risks to a healthy upbringing still distribute themselves across the classes but today when we talk about adoption we increasingly talk about the rescue of poor children by the well-off.

2) Recent scratches on the surface of history

From the mid-18th Century onwards, the state’s support for the abandoned poor increasingly took the form of foster care. Where the church retained a strong hold, residential provision remained popular. State care extended beyond children given up forever to those whose parents temporarily could not manage. When the rates of child abuse became apparent in the mid 1960s, an increasing proportion of those in the care of the state were rescued from parents deemed to be dangerous.

So it came to pass that one pocket on the roulette wheel accommodated three different coloured balls; children given up forever, those given up for a short time and those taken away from reluctant parents. This unsatisfactory mixing, to my mind, explains not only many of the ills of state care but also the folly of those who seek a single solution to those ills. The fact that the pocket is reserved for poor children does nothing to help.

About half a century ago, a common complaint was being made about state care. The grumble originated in the United States, where numbers in care were high and return on investment unclear. The complaint was drift. Children were bobbing around the system with no clear sense of their destiny. Too many were moving frequently from one foster family to another (although probably no more frequently than is the case today). Jane Rowe and Lydia Lambert in their seminal study Children who Wait highlighted the same difficulties in England.

A demonstration project was established in true U.S. style in Oregon in the 1970s. It sensibly introduced a problem solving process for practitioners so that they could gather and use information with greater precision. The work also tried to limit the number of cases a social worker held, so they had sufficient time to think and act effectively. The idea was to get them to make better decisions, quicker.

So far, so good. There was a problem, drift, the failure to decide, and there was a solution to address that problem. But the Oregon work went further. One mechanism for reducing the caseload was lowering the number of children in care, and that was to be achieved by finding adoptive parents. This transfer of responsibility had several perceived beneficial side effects not least, to use the language of the time, that it provided the child with a respected social status in contrast to the second-class status typical of foster care.

From these origins came the concept of ‘permanency’. Soon the problem solving/reduced caseload part of the solution began to take a lower billing. At the top of the display was ‘a family for life’, which could be the birth family, other family members or friends of the family, strangers remunerated by the state, that is foster parents, or strangers who assumed full legal responsibility, that is adoptive parents.

Legislation was passed in England and Wales in 1975 that allowed for children to be adopted from care. Law was further developed in 2002 to increase the numbers on this track, and also to introduce a new category of stranger care called ‘special guardianship’ that formalised the rights of family members or friends who care for a child that is not their own. (By creating special arrangements for poor children, these developments muddied the settled waters of the Children Act 1989 that provided a single set of orders for all, crossing both private and public law).

From these uncertain beginnings the concept of ‘permanence’ has become fixed. I find it both illogical, and wholly lacking in evidence. Answers to four questions might help to change my mind.

First, what does ‘permanence’ mean? I was born into an orthodox working class family with two parents. When I was three, aspiration took my family to a new town. When I was seven, that aspiration produced another move. At nine, the pressure of upward mobility contributed to my mother’s hospitalisation for mental illness and I was shipped off for some months to strangers in a completely new City. By twelve, a clash of aspirations led my parents to divorce and I returned to live 500 metres from where I started. My still striving father emigrated to Australia, followed soon after my 17th birthday by my mother. Five years later they remarried each other, the only part of the story that bothers me still.

Is this permanence? Is the experience of Kintxo’s father, placed in an orphanage for the first 14 years of life more or less permanent?

Second, what problem is ‘permanence’ trying to solve? It certainly isn’t the drift in decision making that set the United States and England to adopting children in care. It certainly isn’t the impermanence of foster care itself, still, as I will show, the primary source of support for children long separated from birth parents, even if, and it remains an if, it is the most likely of the available options to founder.

When I trace the logic in the permanence formulation I find: a system problem (of slow decision making) being solved by a perceived yet unproven theory about how to improve children’s health and development (get kids let down by one family into a better family). That might be a good foundation for progress with other people’s children but I wouldn’t accept it for my own.

The remaining two questions I will try to answer in subsequent blogs, namely, if permanence could be clearly defined would we predict it to produce better outcomes? And, if it is advantageous, is it feasible, can it be delivered for many thousands of separated children?

Stable, committed, and loving

In this second blog I continue to reflect on the Summit held to discuss the adoption of children in care at the Coram Museum in March 2013.  I reflect on Michael Rutter’s summary research on a healthy home environment and continue to ruminate on the value of the concept of ‘permanency.’

Stable, committed and loving

1) Four Dimensions of a Healthy Home Life

A focal point of the Summit was a summary of research about family environments that promote healthy child development. It was provided by Michael Rutter. He said there were four priorities, and in the classic style of the Great Man, he proceeded to number them, firstly, secondly, and so on.

Priority one is to avoid physical and sexual abuse. This is not about physical punishment. It too should be avoided but, as Sara Jaffee’s research shows, it is the effects of maltreatment that matter.

Priority Two is the provision of stable, committed, loving relationships. This is not the same as permanency -indeed in the right circumstances stable, committed, loving relationships encourage the child’s independence of thought and action and, in one sense of the word, a deal of impermanency. Nor do stable, committed and loving add up to ‘bonding’, another less than helpful concept. As the Great Man said, a strong relationship is not always a good relationship. Cassidy and Shaver’s chapter in theHandbook of Attachment provides the best source of evidence on these matters.

Stable, committed, loving relationships show up in measures of attachment -the extent to which the child displays a degree of security that is appropriate for it’s development- and sensitive parenting -the degree to which the mother is able to read and respond to what the child needs. But the accuracy with which these measures predict a good upbringing for the child remains limited.

Rutter dropped into this part of his pronouncement one of those pesky, annoying, evidence based, common-sense facts of life: that children can cope with multiple, loving, committed relationships, maybe as many as four or five.

His third priority is the provision of individually varying authoritative parenting. He felt the need to say it so I will follow his lead and stress that authoritative does not mean authoritarian. Children like structure, order and boundaries to push against. There is no single optimal way of achieving this, so forget about that good parenting template. Slightly troubling to me was the observation that what parents do matters as much to children as what we say. And our kids learn not just from us, but from their friends, their friends’ families and from other people they respect.

The final component of a healthy home environment are multiple learning opportunities. As Rutter stressed, this does not mean our current obsession with the three ‘Rs’ but with helping the child to think clearly, and to be eager and open to learning more, and more again, throughout life.

Actually, Rutter had a ‘fifthly’. He usually does. But it didn’t have much to do with the subject. It was a cry of despair from a man, from a group of people around the world, who have spent their lives meticulously, agnostically, studying these matters only to be overlooked by policy makers who see the world in terms of their own experience or doctrine.

Rutter said that social policy should be shaped by research not by ideological concerns. But from the moment he sat down he was lauded and ignored in equal measure. Social policy shaped by research? Come on Mike, be sensible.

2) Application of this evidence

Any summary of research will be challenged, and no doubt there will be some disagreement about Rutter’s four priorities, or some difference in emphasis. At the Summit, for example, Danya Glaser put as much stress on neglect as abuse, whereas Rutter concludes that the evidence on the former is weaker than the latter. These are important quibbles but for now let’s take the four priorities as given. How might we act on this evidence?

In the previous entry I asked the question ‘is there any evidence that permanence -in the sense of staying long in a single family unit- would produce better outcomes for children? I am going to conclude on the basis of what Rutter said, and the mountain of research that underpins his summary, that, in itself, it would not.

What matters is a minimum of maltreatment plus sensitive, authoritative parenting that generates an eager to learn child.

This evidence might be used as a guide for social workers trying to decide if the long term risks to a child’s health and development warrant removal from birth parents for a short, long or indefinite period. But, as Rutter pointed out, even damaging parental behaviour can be improved so any consideration of separation demands an exploration of the parent’s capacity to change.

Thinking about the family environment most conducive to healthy child development also helps, as Danya Glaser suggested, to select, where it is needed, an alternative place for the child to live. Foster parents, short or long-term, adoptive parents and special guardians should never abuse and they should offer their own style of sensitive, authoritative parenting, and their own ways of stimulating an appetite for learning. Of course, substitute parents of all types also have the capacity to change, for good and for ill.

It is sobering to reflect that any assessment of that capacity is made in the context of a hypothetical child who may be placed and not, as with the scrutiny of errant parents, observation of what is currently happening.

I was thinking about all this during the contributions that followed Rutter and Glaser. My mind wandered and I found myself staring hard at a painting by Charles Brooking of a series of boats at sea (A Flagship before the Wind under Easy Sail, with a Cutter, a Ketch and Other Vessels, 1754). I got to thinking that the focus on adoption was like a focus on the mast of one of the ships in the painting, a small, possibly fundamental, but nonetheless minuscule part of the vista.

We know that about five per cent of children are exposed to severe violence in the home, either watching what their parents do to each other or by their parents beating them. Few of these children will go anywhere near a social worker never mind come into public care or get adopted.

Our collective objective is better health and development for children. One mechanism for achieving that is to promote a family environment most likely to deliver those outcomes. One set of interventions focus on that mechanism and provide support for children living at home with their birth families. Another concentrates on providing short separations away from home, almost exclusively for poor families. Another, also reserved for the impoverished, provides a long term supplement or alternative to the family home in foster homes, adoptive families or with special guardians.

As good as we can make it, this last option will only ever be a tiny part of the effort to improve the well-being of our nation’s children.