The vast majority of parents in the Western world are offered vitamin K for their newborn babies. Most of them choose to have this but there may always be some who will decide to decline this intervention, perhaps because they have concerns about whether the benefits are outweighed by the possible risks, because they don’t want to give their baby anything other than breastmilk unless it is truly necessary or for another reason.
I am really concerned that some of these parents are given a really hard time, both in practice and in the literature, but I am even more concerned that, if parents decline routine vitamin K for their newborn baby, they don’t always receive good information about what they should look for in case their baby is the one in several thousand who experiences the unexpected bleeding that has come to be called ‘vitamin K deficiency bleeding’, or VKDB. I know that others share my concern:
“Although parents ultimately have the right to choose whether or not to administer vitamin K, as healthcare professionals, it is important to provide education regarding the potential complications of withholding vitamin K and the signs of VKDB if vitamin K prophylaxis at birth is withheld.” Woods et al (2013: 402)
With this in mind, and also in relation to another post I wrote about my understanding that the majority of those parents who decline this are declining it as a routine intervention and would be happy to have it given to their baby if there is a specific indiction for this, I want to offer a list of the key things that we might want to suggest that parents look out for in babies who have not received vitamin K. Of course I need to stress that this is for information / discussion purposes only and isn’t intended to constitute or replace individualised midwifery or medical advice.
Some of the key things that we need to let parents who have declined vitamin K know to look out for include:
1. Active bleeding from the nose, mouth, gums, cord stump or the site of a previous medical intervention, such as the heel prick test which is usually offered when the baby is a few days old. It is not normal for newborn babies to bleed, and bleeding should always be checked out, especially where a baby has not received vitamin K.
2. Blood in the baby’s urine, poo or vomit should also be checked out if vitamin K has been declined, although it will often be nothing to worry about, for instance sometimes you see pinkish spots in the nappies of baby girls (called pseudo menses) which are caused by them having been exposed to their mum’s hormones. Also, when urine dries, it can appear pinkish. Statistically, such bleeding is more likely to stem from one of these causes or something like cow milk allergy but any bleeding should be discussed with a healthcare provider as soon as possible and this is especially important where parents have declined vitamin K, .
3. ‘Any bleeding’ also includes unexplained bruising, or bruising that is explained but seems more extensive than might be expected. This can indicate bleeding under the skin, and parents who have declined routine vitamin K should know to look out for such bruising.
4. One of the common sites of bleeding in VKDB is the intercranial area (under the baby’s skull). I think it is important that parents know that, if the baby’s ‘soft spot’ or fontanel seems a different shape from normal, this can indicate that there may be bleeding under the area which is causing pressure, and care should be sought urgently.
5. Finally, any change in behaviour or general health should be discussed with a care provider, especially if the baby becomes irritable, stops eating, sleeps more than usual, experiences vomiting or seems to have paler skin than usual (which in darker skinned babies may be more easily spotted by looking at the gums). This is just as true for babies who have had vitamin K.
Of course, it is often hard for new parents to know what is normal or a change in a baby who is only a few days old, and this is where a good midwife is invaluable as they will be able to help determine that. I have attached a slide which I use when speaking to midwives on this topic – please feel free to use it and/or share it, in combination with tailored information and advice because, while it is really important to support parents making the decisions that are right for them, it is also important that those who decide to ‘wait and see’ rather than to have routine vitamin K need to know what it is that they need to look out for.
Woods CW; Woods AG; Cederholm CK, (2013). Vitamin K deficiency bleeding: a case study. Advances in Neonatal Care 13(6): 402-407.
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