Five things parents should know if they decide to decline vitamin K for their baby

vit kWhat information should we offer when parents decide to decline vitamin K?

The vast majority of parents in the Western world are offered vitamin K for their newborn babies. Most choose to have this but there some decide to decline this intervention. Sometimes this is because they have concerns about whether the benefits are outweighed by the possible risks. Or they may not want to give their baby anything other than breastmilk unless it is truly necessary. In some cases, they would be happy to give it if there was a specific need or risk factor, but not on a routine basis.

Some of these parents are given a really hard time, both in practice and in the literature. I wrote about this in my book, Vitamin K and the Newborn. Worse, if parents decline routine vitamin K for their newborn baby, they don’t always receive good information. And that’s important. Because there are sometimes warning signs. And sometimes, things happen in the first few days of life which can mean that a baby who hasn’t received vitamin K has a higher chance of experiencing a bleeding problem.

 

Parents need good information

No information can replace individualised midwifery or medical advice, of course. And any parent who is worried about their baby should talk to a qualified professional. But there are things that we should be sharing with parents. Things that they can look out for. Things that may help them to know what to look for. Just 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)

I’ve written elsewhere about my understanding that the majority of those parents who decline vitamin K would be happy to have it given to their baby if a specific indication for this arose. And here is my list of the key things that we might want to suggest that parents look out for in babies who have not received vitamin K. Again, this is for information and discussion purposes only and isn’t intended to constitute or replace individualised midwifery or medical advice. If you are worried about a baby, you should seek professional advice, even if they don’t have anything mentioned here.

 

What to look out for

So here are some of the key things that we need to let parents who have declined vitamin K know to look out for.

1. Active bleeding from the nose, mouth, gums or cord stump. Or bleeding from the site of a previous medical intervention. For example, 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. 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. It will often be nothing to worry about. For instance, sometimes you see pinkish spots in the nappies of baby girls (called pseudo menses). These are caused by them having been exposed to their mum’s hormones. And sometimes, when urine dries, it can appear pinkish. Statistically, such bleeding is more likely to stem from one of these causes. Or it can also be due to something like cow milk allergy. However, any bleeding should be discussed with a healthcare provider as soon as possible. This is especially important where parents have declined vitamin K.

3. ‘Any bleeding’ also includes unexplained bruising. It also means bruising that has a known cause but which seems more extensive than might be expected. This can indicate bleeding under the skin. 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). Point this out to parents so that they can see what ‘normal’ looks like for their baby. Explain how, 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. In such a situation, care should be sought urgently.

5.  Finally, any change in behaviour or general health should be discussed with a care provider. (This is true whether or not the baby has had vitamin K). This is especially important if the baby becomes irritable, stops eating, sleeps more than usual, experiences vomiting or seems to have paler skin than usual. In babies with darker skin, any colour change may be more easily detected by looking at the gums.

Be aware that there are things that increase the chance of a problem, such as taking antibiotics, and breastfeeding issues. As a midwife, I have a low threshold for breastfeeding problems in babies who haven’t received vitamin K. Sometimes, breastfeeding issues are the one thing that might have pointed us to a problem, so I urge you to be aware of this too. But if a baby is not receiving adequate milk (of any kind), vitamin K levels may not be optimal. And if any of this is new to you, or you feel you need more information, please read my book.

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. This is where a good midwife is invaluable as they will be able to help determine that.

It is really important to support parents in making the decisions that are right for them. It is just as 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.

 

A note on sharing this information

This blog post features a slide which I use when speaking to midwives on this topic.

Yes, you can share this post on social media, in combination with tailored information and advice.

Please ensure that you always credit the original author and link back to their website, rather than taking their work for yourself. More on that here.

Yes, you can print the picture to show people or put on your wall, but you may not remove my logo and please consider supporting my work and help me keep the free stuff coming by taking one of my online courses, shopping in our Etsy shop or buying my Birth Information Project a coffee.

 

There is loads more about this in my book, Vitamin K and the Newborn. The book also goes through the evidence and is designed to help parents make the decision that is right for them, as well as to help care providers and birth workers better understand the evidence and the issues.

And if you’re a midwife or other birth worker and you’d like to learn more about topics such as vitamin K and discuss how to best share information with parents-to-be with colleagues from around the world, join one of our online courses!

I have written another blog post sharing my answer to one of the questions below about vitamin K and tongue tie division.

 

Wickham S (2018). Vitamin K and the Newborn. Avebury: Birthmoon Creations.

Woods CW; Woods AG; Cederholm CK, (2013).  Vitamin K deficiency bleeding: a case study.  Advances in Neonatal Care 13(6): 402-407.

19 comments for “Five things parents should know if they decide to decline vitamin K for their baby

  1. zoe dixon
    July 28, 2014 at 5:01 pm

    And what all parents must know but are not told is that vit k is held in a bovine solution in the uk because the alternative is too expensive.

    • July 28, 2014 at 5:04 pm

      Yes, though that’s sometimes hard to find out, and often practitioners themselves can’t access the information.

  2. Keelie
    March 6, 2015 at 11:18 am

    Love your website! Would you consider having a facebook page and promoting your posts that way? I looked but couldn’t find you. I get a lot of my birth info through facebook.

  3. Rachel
    November 13, 2015 at 1:33 pm

    I requested not to have the Vit K injection for my son, I’d researched it and looked at all the AIMS information beforehand and felt that as long as baby had had a smooth transition into the world then we wouldn’t have it, I felt confident in my decision, however I was made to feel like I was the worst parent ever. After ‘having’ to transfer to hospital from a planned home birth, the on duty paediatrician told me, whilst on my own, and having had an hour sleep in three days and being quite upset with how the birth was handled, particularly once at hospital, that by not having it I was risking my baby dying or being severely disabled, and was that what I wanted?! He demanded my reasons for not having it and also told me I could not be discharged until the senior consultant had come to speak to me personally. After about three hours he returned to ask me if I’d changed my mind, and to let me know that the consultant was in surgery saving a sick baby’s life but he’d begrudgingly accept my decision. I then waited another four hours before he signed us off and I was ‘allowed’ to be discharged.
    I then spent the next few days fearing my decision and was even more upset about my birth story, having spent another 7 unnecessary hours in hospital, when I’d planned to not be there at all.
    Passing on this sort of information instead of shaming and scaremongering, would have been useful.

    • November 16, 2015 at 7:52 am

      So sorry to hear about your experience, Rachel, but I appreciate you sharing it because it might help other parents to be prepared for what might happen.

      • Amanda
        January 1, 2016 at 6:50 pm

        This is almost dead on the same thing that happened with me when we refused the shot too. We had 3 different doctors come in and tell us how we were horrible parents and how we might kill our newborn baby because of this “silly need” not to give him a shot. Don’t ever second guess yourself. They should give you information both on the shot and benefits and not having the shot and what to lookout for so parents can make well informed decisions.

  4. Josh
    November 16, 2015 at 6:39 am

    https://www.facebook.com/rizzaislamserves/videos/608397669301509/?fref=nf

    Vitamin K exceeds what the FDA allows for aluminium in a baby. Add to that the alcohol in the shot and how that might affect the liver of a just born baby that does not have very good liver or kidney function and just throw in a Hepatitis shot for good measure and it’s no wonder so many kids are getting sick.

  5. Gabbai
    January 3, 2016 at 6:23 am

    So are you promoting the vitamin k shot?

    • January 5, 2016 at 10:17 am

      No, but neither am I saying that parents shouldn’t have it … I’m promoting the idea that parents should be able to access good information from a number of perspectives (as well as information about where we don’t have good information, which is just as important!) and be supported in making the decision that is right for them and their families 🙂

  6. May 24, 2016 at 8:09 am

    Hi Sara
    I have some strictly Vegan parents. I am not sure where they stand on the vitamin K issue however, if they wish it, is there a non Bovine preparation available please?
    Great website- many thanks for all your work
    Katie

    • Annabel Bryant
      February 7, 2018 at 10:22 am

      Many of my clients use the Neokay vitamin K. The 1mg capsules are obtained on NHS prescription from the GP, the 50mcg daily drops can be bought from a pharmacy. It is preserved in coconut oil, and is tasteless and well tolerated by babies. It is supported by the vegetarian society http://www.neokay.co.uk/productinformation.html

  7. Eva
    July 21, 2016 at 5:08 pm

    I have been reading about vitamine K and the emphasis on breastfeeding, and whenever I get pregnant, I don’t think I would choose vitamin K for the baby. I have been passing info to my pregnant niece, she says however she won’t breastfeed. Is it convenient in such situation to opt for vitamin K on delivery? (I understood that in artificial (bottle) baby milk vitamin K is supplied.) Thanks a lot in advance.

  8. eva
    August 25, 2016 at 4:46 pm

    I am not having vit K for my baby I did a lot of research and I feel I don’t want to inject my newborn with Alcohol and Aluminium.

  9. hillypenHilary Pengelly
    January 12, 2017 at 12:13 pm

    Hi Sarah, thanks for this – been looking for resources on Vitamin K for sharing with prospective parents (I’m a doula) to promote discussion and provide information to them for making choices. Have you seen this recent post on You Tube on the issues associated with routine administration of Vitamin K? It’s US based but very interesting…questioning the evidence base for routine administration of Vitamin K to all newborns…
    (https://www.youtube.com/watch?v=gjnAAR8dky8) hope the link works!!

  10. March 1, 2018 at 5:32 pm

    Sara, what are your thoughts on tongue tie division with baby who hasn’t had vit k? If mother has made informed decision, can a medical professional decline to do division?

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