Parenting is full of decision-making and it starts before your child is even born. One of the questions you will get asked during a prenatal appointment is whether or not you want your child to have the Vitamin K injection. To make this decision, you need to be informed about what this injection is for, what it prevents, and any risks it may have (both when administered or when not administered).
*Disclaimer: This blog is intended for informational purposes only. The information on this blog should not be used as a substitute to medical advice or medical treatment. As always, your Primary Care Provider, a doctor, or another health professional is your best resource for specific questions and medical advice. If you believe you or a loved one are experiencing a medical emergency, please contact 911.*
Your healthcare provider should be able to answer any questions you have about the injection and please -ask them. Don’t hold back – you should be making a decision with all the information you require. As I’ve repeated many times before, no question is a stupid question if it matters to you.
As I know that not all situations workout perfectly and sometimes questions do go unanswered or information is not provided in a format or way which helps support your learning, here is a bit of information about vitamin K. As always – I urge you to discuss your decisions with your provider, ask questions, and ask for more information as needed. This post is not a substitute to a discussion with your chosen medical professional.
What is Vitamin K?
Vitamin K is one of the nutrients our body requires to function at an optimal level. It is involved in blood clotting.
Now, I think the term “blood clotting” can be confusing for people. Aren’t blood clots bad? Well they can be when they are somewhere they shouldn’t be or they travel, but we also need our blood to clot or else we would bleed out with a simple injury like a bruise or a cut.
Have you ever heard of hemophilia?
It’s a genetic blood disorder that causes issues with the formation of blood clots. It is related to the lack of specific clotting factors (either factor VIII or factor IX; hemophilia A and B respectively).
I bring it up because, although it is genetic and isn’t directly related to Vitamin K; Vitamin K is an essential component in the synthesis of these clotting factors in our bodies so it highlights what can happen if our body does not have Vitamin K or is deficient in the vitamin.
So, as an example and to highlight the important role of clotting factors in our life (because I can’t *resist* bringing some history in my posts as a past history graduate, not to mention I wrote several papers on hemophilia in the royal family):
You may have heard of hemophilia being related to Queen Victoria and her descendants. Queen Victoria was a carrier, as hemophilia generally presents in males (females rarely present with symptoms, but females commonly carry the mutation and pass it on – it can be explained much more in-depth, but I am not an expert on genetics).
Of her nine children, only one presented with hemophilia (Prince Leopold). He suffered from symptoms from childhood forward and at age 30, he slipped and fell, hitting both his knee and head. He died the next day of an intracerebral hemorrhage.
I could present many other examples, because many of her descendants were afflicted with the disease and unfortunately, many died very young (younger than Prince Leopold who, for a man with his condition during the time he lived, actually survived quite a long time). However, I think the point is clear and I am not in the business to scare people. We need to be able to clot our blood or else something as simple as tripping and falling could end very badly.
How do we get vitamin K?
We make it & we consume it.
We get some from eating things like leafy green vegetables (spinach, kale), soy, or fruits like blueberries and figs.
However, most of our vitamin K is produced by the bacteria in our colons. This could be explained in much more detail, but I’ll save that for the experts (click the link above to read more).
There is also small amounts of vitamin K in multivitamins, and some supplements. Any additional forms of vitamin K like this should be discussed with a healthcare provider.
We make vitamin K in our colons, so why do babies need it?
Well, when a baby is born they have very little bacteria in their colon (or anywhere for that matter – vaginal birth actually transfers a lot of good bacteria from moms to babies, but bacteria in the colon takes months to reach sufficient levels) so they cannot produce vitamin K yet or they cannot produce it sufficiently for our bodies needs.
They also don’t get much vitamin K from mom in the womb via the placenta, or even through breastmilk if they are breastfed.Notably,if baby is formula fed, they do receive a fair amount of the vitamin from formula. If you are a formula feeding mom and anyone ever tries to tell you “breast is best” – just throw that factoid at them. Breastfeeding ain’t perfect, and I say that as a breastfeeding mom but an advocate for baby’s receiving nutrition whichever way works best for them & their family. Please note: The amount of vitamin K in formula is more than breastmilk, but the vitamin K injection is still recommended for all babies.
So basically – babies don’t make it themselves, don’t get much from us via the placenta, and don’t get much in the early days of life unless they are formula fed.
The recommendation is still that all babies no matter how they are fed, receive vitamin K prophylaxis. Lets look at why…
What are the benefits of the vitamin K injection? What are the risks of not getting it?
It prevents VKDB – or Vitamin K Deficiency Bleeding. There are several types of VKDB that can occur (early, classic, and late – you can read more about them & the evidence on vitamin K on Evidenced Based Birth which is an excellent resource that will go into much more detail than me). Early tends to be related to mom taking medications that interrupt the action of vitamin K, but classic and late VKDB are related to vitamin K intake.
Classic VKDB occurs within a week of birth but is rare in those newborns who receive the vitamin K injection. If it does occur it is usually mild, at least in developed countries where resources for treatment are available. In contrast, in Ethiopia the mortality rate has been reported as 25%.
Though classic VKDB is rare, it is still more common than late VKDB, which is good since late VKDB is very high risk. It usually presents as a hemorrhage in the brain (like the one I described for Prince Leopold above) and occurs often within 2-12 weeks of life but can occur anywhere up to 6 months of age. It can be hard to recognize the signs of a brain bleed – because the symptoms can be difficult to pinpoint early on as being specifically related to this cause (such as fussiness), so that is why late VKDB can often lead to poor outcomes.
Late VKDB occurs pretty much exclusively in babies who are breastfed (and this is because breastfeeding = poor source of vitamin K = low intake).
Current data suggests that vitamin K prophylaxis can reduce the occurrence of late VKDB, but it may not entirely prevent it as it has been reported to still occur in a percentage of babies who receive the injection at birth.
The shot does seem to fair better in relation to late VKDB than oral administration of vitamin K however (which is standard practice in some countries).
Verdict: the benefit is that it reduces the risk of a newborn experiencing classic VKDB and also reduces the risk of late VKDB occurrence (but it’s not perfect – as with any treatment). You are therefore reducing your babies chance of bleeding excessively, and in severe scenarios or with late VKDB, potentially reducing their chance of death (which would be the risks of not having the injection).
What are the risks of getting the injection?
I implore you to refer to Evidence Based Birth if you have concerns about ingredients because there is information regarding this is on that page and it is reliable, unlike some sources on the internet. The page on vitamin K is available here.
Side effects of the injection include: pain, redness, bleeding or bruising at the injection site (like any injection). Yeah, that’s pretty much it.
EBB does some great myth-busting in relation to common claims against the use of vitamin K in newborns, but in as short summary:
- Traumatic birth increases the risk of VKDB – false
- Babies are at risk for leukemia if they get the shot – false (this was disproved by multiple studies but is a myth that is still perpetuated by many sites online)
Can I just give my child oral vitamin K instead?
Oral medications and babies are difficult. Have you ever tried to give your baby any oral medication – such as Tylenol? Often some gets spit up or it may be challenging to administer. Similarly, the absorption rate is not always perfect. These would all be challenges faced with oral administration.
There is a 3-dose schedule that is followed in some countries, however this has its own issues as well in regards to the above, but also parents remembering to administer it. Data shows that it is not as effective at preventing late VKDB if given in 1mg doses (2mg doses may be as effective).
Depending on where you live, it may be an option to do oral vitamin K if you are not comfortable with the injection. For example, in Canada if you decline the shot there is usually the option to do the 3 doses of 2 mg orally. This would be something you would want to discuss with your healthcare provider though, because as I’ve mentioned there may be risks or extra considerations to take when considering oral administration.
I don’t usually talk about my personal choices here, but I think it’s important that I start to. This doesn’t mean that my decision is “right” for everyone, but I am a real person and a mom so I like to share my thought process and decision.
Vitamin K was a no-brainer decision for me. Although VKDB is rare in developed countries, I knew I wanted to breastfeed (which is a late VKDB risk factor) and I also knew it still could happen. Since the injection presents with only the side effects of any other injection, benefit certainly outweighed risk for me and both my husband I said “yes, yes, yes” to the question of administering it when it was asked. Maggie didn’t even notice the injection being administered, and never had any redness/soreness at the site. It is administered in the vastus lateralis muscle (in the leg) and I was breastfeeding her while she received it so she was not paying any attention at all.
I would make the same decision again if I had to, and I will be giving it to any of our future children as well. Keep in mind – this is my decision, how I weighed pros and cons. Everyone is different with different values, but if I am being honest I think this is one thing where the risk of administration is almost zero and the benefit could be immense.
As with all parenting decisions, vitamin K prophylaxis is a personal decision that should be an informed decision. Make sure you have all the information you can get access to and make sure that information is reliable. Many websites that claim to be “health” websites are not reviewed or written by medical professionals. I’ve written an article in the past about how to find reliable resources online, but your #1 resource was always is your healthcare professional. They know you and they are there to answer your questions and address your concerns.