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 of them choose to have this but there may always be some who will 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 or for another reason.

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 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)

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 today, I am reposting 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.

As a midwife, I have also learned to have a very 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. If a baby is not receiving adequate milk, vitamin K levels may not be optimal.

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. This blog post features a slide which I use when speaking to midwives on this topic, so please feel free to share this post, in combination with tailored information and advice. 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.

 

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.

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. Francois Arseneau
    July 18, 2016 at 6:55 pm

    I would almost bet a coffee that this bleeding risk they’re trying to prevent with a VitK shot is caused by something they’re doing, for example, vaccines during the first few hours of life. Vaccines cause bleeding and brain damage.

    • Anna Nuttiere
      November 5, 2019 at 6:59 pm

      …. please share your evidence?

  8. 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.

  9. 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.

  10. 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!!

  11. 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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