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.
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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.