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Risks and Benefits of the Vitamin K Shot vs. Oral Dose for Newborns

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Vitamin K Shot for Newborns

On day four of Gabe’s life, we found ourselves in the emergency room getting a quick blood test for bilirubin levels.

The kid hadn’t had a bowel movement for 40 hours and was looking a little yellow, and since it was a weekend and labs were closed, the ER was our only option to make sure he wasn’t seriously jaundiced.

The irony after having a baby at home and avoiding hospital germs was heavy upon me, you betcha.

He was perfectly fine, so I figure we paid about $1000 for this blog post. I hope you enjoy it!

Gentle Lessons on Vitamin K

My consolation when we left was that the staff had been so wonderful, clearly caring about our little one as much as we do. The resident doc on call had a little talk with us about the Vitamin K shot.

The concern in his eyes was evident as he told us he really strongly recommended the Vitamin K shot. You see, they had treated a baby with late onset hemorrhagic disease the month before…and I guess it was pretty awful.

I didn’t have the guts to ask what the outcome was for the child, nor would HIPPA likely allow him to answer, I figured. But it was clear that the entire staff was worked up about it, and he said they were now all on high alert about Vitamin K and its importance.

He shared how hemorrhagic disease works – that babies can have bleeding in the brain as late as 3-6 months of life – and it’s really hard to catch in time because parents aren’t exactly thinking “Lethargy = brain bleed.”

It had been so long since I’d done research on the subject – we had been opting out of K since my 6-year-old was born – that I couldn’t even remember if I knew what the risks of not getting it were.

Perfect lips

I said I wasn’t a huge fan of most of the other ingredients usually found in injections and asked if there was an oral dose available. I was counting my lucky stars that I had just read something that week (from a reader, maybe) about how the oral K is a better option than the shot.

He said that they could offer that to us, but that it did include multiple doses that we would have to administer at home over the next few weeks.

I asked to see the ingredients and apologized for being “that mom,” but that “I don’t put anything into my baby I don’t understand.”

I might have to eat those words someday, but I’m doing the best I can with the resources and energy I have.

Here is the ingredient list they shared with me from the pharmacist (actually his “recipe” to make the liquid):
  • Phytonadione suspension 1 mg/mL
  • Crush (6) 5 mg tabs.
  • Add 5 mL purified water and 5 mL methylcellulose.
  • Add sorbitol 70% to a total volume of 30 mL.
  • Expiration: 3 days. Refrigerate.

I was looking for artificial colors, parabens, other stuff I recognized as being nasty.

And I recognized sorbitol.

I got hung up on it as a sugar alcohol, a sort-of artificial sweetener pegged as “natural” but not really.

We Googled – it didn’t sound horrible, but some people get diarrhea if they chew gum including sorbitol daily.

We probably should have embraced that one considering we were in the ER for constipation, right?

We left with the information, the recommendation, and a prescription for our pharmacist to mix up a suspension of Vitamin K for us (which apparently we would have had to order and pick up multiple times, now that I noticed it has to be refrigerated and only lasts 3 days). I get that parents wouldn’t all do that. I totally get why docs default to the shot.

I wasn’t sure I wanted to do it either.

What is Hemorrhagic Disease?

More recently renamed “Vitamin K Deficiency Bleeding” or VKDB for accuracy, hemorrhagic disease of the newborn (HDN) is a bleeding disorder that occurs when the blood doesn’t clot.

Bleeding might be an issue at a circumcision point, belly button area, or (ironic) places where there has been a needle stick – and these are not great, but the real problem is if bleeding occurs in the gastrointestinal tract or the brain.

That’s where it often strikes in later onset VKDB, through 3-6 months of age.

That’ll land a baby in the hospital, and he might not make it out.

Scary stuff.

Some quick research showed us that newborns who get the shot have (pretty much) zero chance of developing VKDB, early or late.

Babies who take the oral dose still have some risk of deficiency, particularly late onset (which is worse).

As with so many medical decisions, this one didn’t seem as cut and dry as it used to.

I thought the Vitamin K shot was only needed for the first 8 or so days after birth.

I thought breastfeeding had to be “enough.”

I thought it wasn’t a big decision.

But it was.

And my biggest lesson?

Don’t rest on your research laurels.

We’re learning new things constantly and the technology and medications are constantly changing as well.

So just because you did or did not do something with one child doesn’t mean you should blindly follow even yourself with the next one!

I felt like the walls were closing in on this issue, and that we should give Gabe Vitamin K.

I just wasn’t sure if oral, with sorbitol, or an intramuscular injection would be preferred.

Vitamin K Shot for Newborns

Vitamin K for Newborns: Shot vs. Oral Dose?

My husband read this article by Dr. Mercola and was a little disgusted that the good doctor put so much weight on the psychological harm of any injection so early in life. This article is a little silly, like Mercola is trying to look for a reason to make the “don’t do it” recommendation.

There are three primary areas of risk associated with these injections, according to Dr. Mercola:

  1. “Among the most significant is inflicting pain immediately after birth which has the potential to cause psycho-emotional damage and trauma to a newborn.” Really??? Come on, Mercola. Anything could be traumatic just after birth. There’s probably no more risk to a shot than to a bath! Newborns don’t know it’s any more painful than being cold and alone.
  2. “The amount of vitamin K injected into newborns is 20,000 times the needed dose. Additionally, the injection may also contain preservatives that can be toxic for your baby’s delicate, young immune system.” There are shots with no preservatives…
  3. “An injection creates an additional opportunity for infection in an environment that contains some of the most dangerous germs, at a time when your baby’s immune system is still immature.” At your own risk, I suppose. Our last baby was born at home, so no crazy germ-filled environment of the hospital.

Dr. Mercola’s guest dispelled the myth that the K shot causes leukemia, confirmed that the less expensive Vitamin K1 is just fine for the clotting intention of the injection, and seemed to support both the K shot or oral dose.

With most of the objections a non-issue in our minds, the big question left was:

What’s really in the shot?

Vitamin K Shot Ingredients

This site lists ingredients in a shot with NO preservatives like the one my midwife could offer:

  • 1 mg of Vitamin K1, a fat-soluble vitamin derived from plants
  • 10 mg of Polysorbate 80, which helps Vitamin K1 (a fat-soluble Vitamin) dissolve in liquid for the injection. Polysorbate 80 is made from natural sorbitol and plant-based oleic acid, is used in a wide variety of foods, medicines, and vitamin supplements, and is included in the Handbook of Green Chemicals.
  • 10.4 mg of Propylene glycol, which helps absorb extra water and maintain moisture in certain medicines. Propylene glycol has been recognized as safe by the FDA for use in food products.
  • 0.17 mg of Sodium acetate anhydrous, a mixture of salt and bicarbonate, that is used to adjust the pH of the injection
  • 0.00002 mL of Glacial acetic acid, also known as vinegar, that is used to adjust the pH of the injection

You know what’s crazy? In the first week of my newborn’s life, after doing some research but mostly talking to our midwife, whom we trust, we just went for it.

On day 8 of Gabe’s life, without actually reading the ingredients, we injected him with the Vitamin K shot at home, while he happily nursed his cares away.

His body was certainly starting to synthesize Vitamin K in the liver already, so the shot will only protect him from late-onset VKDB, and I hope we did the right thing.

Sometimes, there’s only so much one brain can handle, and my brain had had it.

I’m just counting on my sources from reading this week being correct, and that the benefit of the intramuscular shot – that it may release Vitamin K slowly into the body over time – ends up being a good thing for our little guy.

Baby in monkey hat

Other Important Tidbits About Vitamin K and Newborns

  • One can get adequate amounts from foods: K1 from leafy green vegetables and K2 synthesized from the bacteria in our guts, but also in foods like grassfed beef and dairy, butter and cheese, egg yolks, and organ meats.  (sources: 1, 2, 3)
  • Very little K crosses the placenta.
  • Mothers do demonstrate a marked decrease in Vitamin K in the third trimester of pregnancy, and one theory is that they are passing it on to baby, but that’s not been proven.
  • Vitamin K does move through breastmilk, so supplementation in the mother could help (after birth).
  • Vitamin K deficiency also can cause tooth decay…not a problem for Gabe of course, but perhaps he siphoned some of mine – more on that next week!
  • The Internet, as usual, is full of misinformation, including lists of ingredients that include aluminum, preservatives and other weird ingredients, the leukemia myth, and more. Perhaps you need to ask for the preservative-free version, but those ingredients lists can’t be a deciding factor in my opinion (unless the preservative-free version isn’t available).
  • Breastfeeding is a major risk factor for VKDB. Formula-fed infants don’t really experience it at all.
  • The cause of much VKDB is completely unknown.
  • The shot has been the standard of care since 1961.
  • It wasn’t until 1999 that the medical community officially realized that Vitamin K deficiency could cause bleeding beyond the first few weeks of life…

Sources: 1 (from our midwife), 2 (from the ER doc), 3, 4, 5, 6

I’m still not sure if I made the right decision in my postpartum haze.

IMG_9060_edited-1

But each decision, each vaccine, each medication recommended, is an individual decision for that child, for that moment in time, with the information we have available.

This time, this place, this baby…we did it.

And as confusing as the process was (and is, to an extent), I know that when I look at that sweet little face, all I want to do is protect him from the ills of the world, cuddle him close, and love him harder.

Will you give your baby the vitamin K shot? Or the oral dose? Do your own research and be informed before baby arrives.

Other labor and delivery posts:

48 Bites of Conversation So Far

  1. Yeah. I get this. My first 6 kids didn’t get it, but they were the full term, born at homes. My 7th (high risk preg, c-section 27 weeker preemie) did. He had several risk factors so I weighed the risk/benefit and went for it. There is a time for balance and not adhering to rigid dogma.

  2. Oh thank God you gave it to him! I didn’t have my first 2 babies get Vit. K because of all the misinformation I read. Then all the cases of Hemorrhagic Disease in newborns started popping up and I began to read about the REAL risks of not giving Vit. K to your newborns and what life looks like after a newborn has it (if there is a life after even). That put some sense into my head. Here was one story about life after (this lady’s first 6 kids were fine without the Vitamin K, but her 7th suffered):http://judahsjourney.com/about/

    I consented to the Vitamin K shot for my next 2 babies and I will for this one as well. The benefits outweigh any risks.

    I am thankful my first 2 children, but especially my first child was okay without the shot. He was soooo at risk for a brain bleed because of his traumatic birth and his injuries, but I didn’t understand the need for the Vit.K shot and the midwife never brought it up. I will regret that forever.

    • No regrets on this one, good mama! You did the best you knew, and luckily there aren’t any long term risks now, so it all worked out. Don’t beat yourself up over that one, just take one step at a time and keep learning. That’s my big lesson here too! Hugs, Katie

  3. Thanks for sharing! I’m surprised that they even offered the oral. I gave birth a year ago in a similar part of the country and that wasn’t an option at the hospital I was in. Maybe because of the recent events at the one you were in? As far as I had read you had to order it online. A question that I have that I haven’t seen any sort of answer for is why are supposedly all newborns deficient in vitamin k? We’re we created/designed that way for a reason?

    • Carrie,
      If you click on my sources, I’m pretty sure at least one of them references that question, or something else I read. One theory is that it’s partly because moms aren’t getting enough Vit K to spare (so maybe it didn’t used to be a problem). Another is that it’s only going to kill a small handful of children, so “survival of the fittest” never really played in to fix the problem. Or it could be something about heat, some long “thermo….” word, and that it might actually have helped us before we lived in houses and such, with this one major unfortunate side effect.

      I was surprised they had the oral too and I wish I wouldn’t have gotten scared by the sorbitol! I think if I had to make the call today, I’d probably do the oral…or nothing again. It’s soooo tough!
      🙂 Katie

      • I wonder about the cause of low Vit K too and read a comment online somewhere from someone (a nurse) much more knowledgeable than I, who hypothesized that low Vit K may be beneficial because of changes to the heart and lungs that occur at birth, when the baby goes from a fluid filled environment to relying on breathing air. I know that’s really vague, and I’m doing a huge disservice to that random internet strangers idea.

  5. Ahhh Katie…there you go, mixing me all up one week before I’m supposed to give birth to my baby boy. I’ve already submitted my birth plan without the Vitamin K…

  6. Nothing is cut and dry, for sure. If you felt that was the right choice, then no doubt you made the right choice. My first was born in the hospital and we did have the vitamin K shot, although we opted out of some of the other treatments. With my second, he was born at home, and he had oral vitamin K drops. they seem to be in some kind of oily yellowish base. I am not sure if they had the same ingredients as the drops you mentioned…

    I wonder if God would have created us in such a way as we to need a vaccine or special formulated drops as infants, in order not to hemorrhage. And we were obviously created to breastfeed… So it’s surprising that that creates more of a risk!I don’t know—none of us have all the answers. And it seems that vitamin deficiencies are far more common now in this less perfect world then they may have been at the beginning of creation. That may be a large piece to the puzzle.

    Thanks for a thought provoking post 🙂

    • Rebecca,
      I love your thinking! It IS a puzzle to be sure, isn’t it? I don’t think bfing is a “risk” per se, but that formula is fortified with a whooooolllle bunch of Vitamin K. So they basically get the oral dose in their bottle IMO! I bet it has to do with our diets as moms…but who knows?
      🙂 Katie

  7. Hi Katie,
    I just wanted to let you know that I am a crunchy, breastfeeding mama and our second child did not get Vitamin K at birth (our first homebirth – we figured we were not getting the Hep vaccine or the antibiotic for the eyes, so the Vit K was probably not important either) and he had a brain bleed when he was four weeks old. This caused a major stroke and he now has only a portion of the right hemisphere of his brain left. His left hemisphere is completely gone. We also don’t believe that God creates babies with a “vitamin deficiency” but I do think we could have created the deficiency with our modern diet (we eat an exceptionally healthy diet rich in Vitamin K2, but not necessarily enough leafy greens during pregnancy). We didn’t get an overnight healing either; instead we are on a long journey of therapy. Neuroplasticity is real, but it’s not like flipping a switch. Our little guy is a huge blessing, and we love him so much exactly as he is, but I do wish we had just gotten the stupid shot.

    • Nicole,
      Thank you for being so real and open to sharing your story…it breaks my heart, and I can’t even imagine how difficult the entire experience was for you, in so, so many ways.

      Even with a great diet, horrible things can happen…and who does eat “enough” leafy greens? It’s a very, very good reminder to everyone out there not to (a) rest on the laurels of thinking your diet is premier and (b) not opt out of anything without TRULY doing the research. Your quote “we figured we were not getting the Hep vaccine or the antibiotic for the eyes, so the Vit K was probably not important either” could easily come out of my own mouth and probably many other readers as well…so it makes me thankful that I did get the stupid shot, even though it was a wild ride of a decision. Thank you, thank you again for sharing, and I’ll be praying today for your little guy’s healing journey to be successful.
      {hugs} Katie

    • Nicole, I’d love to connect with you. Our story is almost identical to yours. We are a crunchy, breastfeeding, homebirthing family. My first 5 children did not receive the shot and were fine. But with our 6th it was different. At 5 weeks old he had 2 spontaneous brain hemorrhages. We were told that if he survived, he’d be brain dead, blind and deaf. We’re also walking out the road to recovery through therapies, Anat Baniel method, hyperbaric oxygen, and more. My email is [email protected]

  8. I felt confused about the vitamin k shot too. But, after weighing the risks (not many) with the benefits (basically guaranteed no late hemorrhaging) I went for it. And I’m very comfortable with that decision.

  9. We are all under the curse, so nothing is as it should have been – perfect. If babies are born possibly deficient enough to cause brain hemorrhage – I think it is better safe than sorry.

    I can’t breastfeed because I was born with an abnormality – I’m sure God didn’t “create” me with that way but it is part of the curse. We need to quit thinking that babies should come out perfect with everything they need and that even our breastmilk will provide everything they need. Thank God for science – far fewer babies die nowadays and women like me (who can’t breastfeed) are able to still have children and feed them through formula.

    • I have the same thinking. I have hypoplasia and IGT (insufficient glandular tissue) and have been unable to nurse all my babies as well. While incredibly hard for me to accept and move past, I think it really pushed the point home for me that this world is no longer perfect and what God once designed as perfect doesn’t exist anymore. It’s fallen. Sure, sometimes things work out great, but there are just no guarantees by purely trusting nature.

    • Thank you for saying this. And the other commenter too. This is what I was thinking reading all the worries about being created with everything we need for life and health. We weren’t created to get sick and die, it’s all part of the curse. Praise God that in His grace He provides help and vaccines and brains to figure it out.

  10. We had the oral…now I’m scared! Is there a way of checking if the baby has enough vit k to avoid this? Blood test?

    • Valerie,
      That question is well beyond the realm of my expertise, but I’m sure you could call your doctor. If your baby wasn’t high risk, I’m sure doc knew what s/he was doing with the dosage. If you only had one dose, you might want to ask some more questions though?
      (Don’t be scared…) 🙂 Katie

  11. So how many babies dies of brain bleed per year vs how many babies born? When weighing risks, considering the odds is good to consider.

    • Jen,
      Good question, I’m surprised I didn’t include that. It’s not many, really, but let’s say “how many experience brain bleed” because it’s bad enough to ALWAYS be a crisis even if the baby lives through it. Evidence based birth states 2% of total births died by the 8th day before the K shot was used – so that doesn’t include late onset. And 2% is kind of significant!

      Here are the stats on late onset only, copied directly from Evidence Based Birth:
      * When infants do not receive any Vitamin K at birth, statistics from Europe show that 4.4 to 10.5 infants out of 100,000 will develop late VKDB. Rates are higher in Asian countries (1 out of every 6,000 infants).
      * When infants receive oral Vitamin K at least three times during infancy (typically at birth, one week, and four weeks), anywhere from 1.4 to 6.4 infants out of 100,000 will develop late VKDB.
      * When infants receive the Vitamin K shot at birth, anywhere from 0 to 0.62 infants per 100,000 have VKDB. In an 18 year period in the United Kingdom, only two babies who received the shot had late VKDB brain bleeds, out of 64 million births (Busfield et al. 2013).

      Thanks for asking!
      🙂 Katie

      • That is a good point to take into consideration any baby that experiences brain bleed. Thanks for the info.

      • Are there any anecdotes or statistics regarding number of babies injured in any way from getting the K shot (or oral dose)? I know there’s plenty regarding vaccines, but I haven’t come across anything about k intervention.

  13. Just yet another consideration…I have Celiac Disease…and don’t absorb Vit K well. So— sigh….we are getting the shot for the baby. Due in a week with Baby #4. 🙂

    • This is me as well. When you have Celiac, your body doesn’t absorb vitamins and minerals like someone without it does. With our 18 month old we did the Vit K shot but nothing else. I asked for oral, but the hospital doesn’t offer it. We will do the same with #8 due next month.

  14. Thank you for the post– I had not heard about this. We didn’t do Vit K on our last two boys because I had read it increases the chance of jaundice (my first two had jaundice and the shot, last two did not have jaundice at all). Have you heard this as well?

  15. Yes. I’m a VERY big proponent of the vit k shot. I can share our story too. Our child had late onset vkbd. I had a good amount of vit k consumed during pregnancy and no family history of bleeding disorders that we know about. She was born peacefully at home, ebf with no issues. And at 5 weeks she was in the hospital getting a ct scan, 2 spinal taps, pumped full of abx, getting blood and plasma transfusions so that she would live. And fortunately she suffered no brain bleeding. All because we forgot to have the MW give her the vit k shot.

    If you decide that it’s not for your family, that is totally your decision. We seriously don’t care about whether you vax or not or do vit k or not. Each girl and dh and I have different needs, so we don’t even have the same vaxxes/no vaxxes.

    But I know that no one had told us of the possible side effects of not getting the vit k shot. Every decision, whether you get it or not, has potential side effects. For us, the proven benefits of this far outweigh the potential risks. And if you look at the efficacy rate of the vit k shot, it’s very, very high.

    I’d also been told that “if you just up your vit k3 intake prior to birth, you’ll be fine”. But if you look at the numbers of deaths from vkbd in countries that typically have higher rates of consumption, you’ll notice that vkbd deaths were higher there, prior to the shot, than in countries where vit k3 consumption isn’t as high.

    There is no test to determine whether your baby needs vit k or not. If they are born with certain diseases, then they are more likely to develop vkbd. But two of the risk factors for late onset vkbd are breastfeeding and no vit k shot. Since formula has a higher amount of vit k than breastmilk, most babies that are on formula, don’t get vkbd.

    The reason we prefer shot to oral is that the efficacy rate is much higher with the shot than the oral version.

    Oh, and the only reason our child didn’t die is because my husband and I knew something was off with her. She wouldn’t be comforted–wouldn’t nurse to sleep or be comfortable nursing with me in the tub, or anything. Friday afternoon we called the doctor and she told us to go into the ER at the local Baby-Friendly hospital. The first doctor to see us wanted to discharge us for ‘fussy baby’ (aka, you’re a stupid mom that doesn’t know how to comfort your child) but the head of pediatrics (who knew our pediatrician) asked us to keep her overnight. That jived with my mama sense. They’d put an IV in her and it just wouldn’t stop seeping blood from the site. The nurses and I kept pointing that out, but it kept being brushed off. Until finally we figured out vkbd.

    It was scary and horrid and nothing I would wish on any parent. But none of these things are mentioned on the sites that talk badly about vitamin k. With vkbd, there are no natural remedies.

    • Loralee,
      How awful – but I’m so glad you shared your story and that your daughter is okay, and also that you don’t sound bitter at all, just informative and passionate, rightly so. Thank you so much for taking the time to tell us all of this, even the details about the IV bleeding! You’ll probably help save a baby’s life with this comment…
      Best,
      Katie

  16. I really appreciate your honesty in this post. It’s not always a cut-and-dried decision, and if you recognize that, you’re less likely to judge others for their decisions.

    • Whoa. That’s compelling and scary. I had to look at the ingredients for the Vitamin K shot to see if there was any lecithin because our little Gabe seems to have an egg allergy out of nowhere. 🙁 Here’s hoping the shot my midwife had was the same as what I typed in this post…and that he grows out of the allergy!
      Thanks for sharing this – totally fascinating!
      Katie

  18. Kudos to all the moms who weights their options well. I am an OB nurse of 30 years and I always advise my patients to be their own advocate. I have given vitamin K to hundreds of babies and is a strong proponent of giving it to infant because of the risk of hemorrhagic disease, For me the benefits outweighs the risk, big time. The medical community does not offer oral vitamin K as an option either because vitamin K is synthesized in the liver with the help of bacteria in the baby’s gut, and newborns are born with nothing. Their guts are sterile. making oral vitamin K ineffective. Eventually bacteria starts to grow, but it is not known how long and will it take before the infant’s body can fully synthesize vitamin effectively to obtain sufficient level in their blood, which in turn will help prevent bleeding. As always, consult your own doctor and read articles from websites you can trust. There are tons of information out there but many are unreliable.

  20. Was the not pooping a warning sign for the vkdb? Or just yellowing? My son received oral but has been having trouble pooping. I have just been wondering if I made the right decision.

  21. I teach childbirth classes and I’ve had two moms recently tell me of babies they knew with internal bleeds from late VKD bleeding. One had a nephew who experienced it, another had her best friend experience it with her baby. I wasn’t sure what to do with my daughter, and I too was turned off by Dr. Mercola’s article. After talking to a friend who is a neonatologist, we decided to get it. Since my daughter was born, Evidence Based birth published their article on the subject and I am convinced of the importance of the shot. Thank you for sharing this!

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Please remember that I’m just a gal who reads a lot and spends way too much time in her kitchen. I’m not a doctor, nurse, scientist, or even a real chef, and certainly the FDA hasn't evaluated anything on this blog. Any products mentioned are not intended to diagnose, treat, cure, or prevent any disease. Please talk to your health professional (or at least your spouse) before doing anything you might think is questionable. Trust your own judgment…I can’t be liable for problems that occur from bad decisions you make based on content found here.

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