**Updated on 11/16/15**
Yesterday, Good Morning America featured a segment (I can’t call it information or journalism because it was neither) on the vitamin K shot. Basically, they sat down with a doctor who said things like:
- “There are no downsides to it.”
- “1 in 100 babies used to have serious bleeds before we gave the shot.”
- “It’s just all those parents who don’t want to give their babies vaccines.”
- “It’s perfectly safe.”
- “Parents don’t want any medical care for their babies.”
The “journalists” (they are not) sat there and nodded sympathetically, especially to the part about parents who don’t vaccinate. This is absolute nonsense. I mean, does anyone even take these people seriously anymore? It’s absolutely bizarre to claim that something is “perfectly safe” because nothing is. (Everything has some risk.) And that part about parents not wanting any medical care? Have they ever bothered to ask parents why they are opting out?
At any rate, no — they don’t ask, they don’t want to know, they are comfortable in their assumptions that parents who ask questions about medical procedures are crazy and that the shame is justified (it’s not).
I believe parents deserve facts about these decisions so that they can make the best call for their children. They are smart enough to do that. I believe they need to have conversations with medical professionals that allow them to know the actual risks and benefits and then make an informed decision. You need that, mamas. You deserve that.
And for those who don’t know, you can ask any questions you want of doctors. You can refuse any procedure you want. You do not have to do what they say just because they are doctors. Your body or your child’s body, your choice. Period.
What About Vitamin K?
Let’s take a look at the facts about vitamin K.
Vitamin K is an essential vitamin. It is one that we need to get from our diet, and it plays a major role in blood clotting. Although our guts can synthesize vitamin K in small amounts (primarily the bacteria known as Bacteroides), we can’t make more than about 10% of what we need — and that’s assuming our gut flora is healthy. Over 90% of what we need must come from food like leafy greens (K1) or natto, or specific hard cheese like gouda or Romano (K2). K1 is water soluble and K2 is fat-soluble. There are also synthetic forms, known as K3, K4, and K5.
Without enough vitamin K, people are at risk for internal or external bleeding, which can be uncontrolled and lead to serious consequences or even death. With too much vitamin K, we could end up with blood clots that could cause strokes or other serious consequences. Like most things, our bodies need to maintain a steady amount — neither too much nor too little. It doesn’t take much though, for blood to clot properly. The RDA for adults is 120 mcg for men and 90 mcg for women.
So we know that vitamin K is necessary and that there are definite risks to having too little. Let’s look now at the issue with newborns.
Newborns and Vitamin K: The Normal Experience
The media would have you believe that parents are refusing the vitamin K shot because they think it’s a vaccine (it’s not) or that they just want to keep their perfect little baby “natural.” Of course, it’s much more complicated than that.
When I began this research, I believed what I had read: that vitamin K doesn’t cross the placenta, that all newborns are deficient, and that levels rebound within 8 days.
But it turns out the evidence doesn’t really support any of that.
After finding a whole lot of assumptions in the recent studies (from the last 10 years) with no data explaining how they were arrived upon, I looked back at studies from the 80s, hoping to find the ones that led to what we believe today and what informs the clinical practice of giving vitamin K shots to all babies. What are ‘typical’ newborn levels? What studies were used to find that, how large were they, how healthy were the mothers and babies?
The studies that the “low vitamin K levels” were based on (that I found) tended to be fairly small (fewer than 40 mother-baby pairs) and many looked at the levels found in cord blood rather than the baby directly. And their results varied quite widely.
Some found that vitamin K doesn’t cross the placenta at all. Some found that it does cross the placenta, but only under certain circumstances — it doesn’t happen readily. It may happen if a mother supplements with vitamin K during pregnancy, especially in the final days before birth (it seems to only happen when mothers have high levels). In fact, mothers who consumed natto during their pregnancy (which is rich in vit K2, MK-7) had placentas with much higher levels of vitamin K than mothers who didn’t supplement.
The newborns in the studies did tend to have low levels of vitamin K, which ranged from 0.2 – 1.18 ng/mL. And most interestingly, whereas we’ve been told that levels rebound to “normal adult levels” by about 8 days of life, they actually do not (they do rise for the first 10 days, and then begin dropping again later). In one study, levels dropped after the first month, reaching the lowest level around 6 weeks of age, and stayed down for the first six months of life (with exclusive breastfeeding). The average level in the first six months of life was 0.2 – 0.24 ng/mL, about half of the average adult level.
So we know from this information that a lot of what we have been told about vitamin K isn’t true.
- Vitamin K can cross the placenta, but only under very limited circumstances
- Supplementing vitamin K during pregnancy can raise the newborn’s stores somewhat (but not in all cases)
- Levels of vit K remain low in exclusively breastfed infants until the introduction of complementary foods/formula (but this doesn’t pose a problem and isn’t considered deficiency)
- Supplementing vitamin K while breastfeeding can raise levels (but this usually isn’t necessary)
This leads us to believe that for the vast majority of babies, vitamin K supplementation is not necessary.
So why do some babies experience problems?
Why Vitamin K Deficiency Bleeding Occurs
We all know that, unfortunately, not all babies are healthy and that some do experience vitamin K deficiency bleeding (VKDB). VKDB is broken down into three categories: early, classic, and late.
Early VKDB is typically (almost always) found in babies whose mothers are on some kind of drug that lowers vitamin K levels, and it presents within 24 hours of birth. If your baby is at risk for this, you will know.
Classic VKDB is often related to delayed or insufficient feeding and presents within 24 hours to 7 days after birth. It is typically mild ( bruising, some bleeding) but can become more serious in some cases.
Late VKDB is very rare but very serious. The incidence is around 1 in 15,000 in babies who don’t receive a vitamin K shot, and babies who have liver problems or gut malabsorption issues are at greater risk. This is seen almost exclusively in breastfed babies because formula has vitamin K in it. About 20% of babies who end up with late-onset VKDB die and many have neurological damage.
So, obviously, this is serious. But we have to ask — why breastfed babies?
Levels of vitamin K are sharply lower in breastmilk than formula — but we covered above why, for most babies, that isn’t an issue. Why is it an issue for some? What is causing this to occur?
We know that the babies with liver issues and gut malabsorption are at greater risk, which tells us that clearly, something is wrong, and that is leading to this problem. Vitamin K is largely stored in the liver, so if there is liver damage or an immature liver, levels will be lower and this could be a risk factor.
The other major issue is gut health.
An infant’s gut flora is needed to synthesize vitamin K, and also break down and absorb what is in their diet. If they do not have healthy gut flora — or rather, if mom doesn’t — then they will not get adequate vitamin K. There is not a lot of evidence in this area yet, but there is some evidence that poor colonization can lead to low vitamin K levels. Of course, breastfed infants will naturally have low vitamin K levels because their gut flora is primarily lactobacillus and bifidobacteria, which don’t synthesize vitamin K. Formula-fed babies will have high levels because of fortification of formula and because formula produces different gut flora, including Bacteroides, which do synthesize vitamin K.
(But we need to recognize that exclusive breastfeeding is the biological norm and that breastfed babies actually have “normal levels” in most cases, while formula-fed babies have “high levels.”)
I believe there is enough evidence to show that babies who have late-onset VKDB are unhealthy, and have specific risk factors that can and should be identified, and treated. That is, the underlying causes should be treated — not the vitamin K levels specifically.
Is The Shot Needed?
For healthy babies without risk factors, no. (We’ll talk more about risk factors in a minute.)
In fact, the shot has been associated with a couple of problems:
- May be associated with childhood leukemia (the evidence isn’t definitive either way)
- Concerns about preservatives in the shot (benzyl alcohol has been associated with fatal “Gasping Syndrome” in premature babies)
- Concerns about aluminum in the shot (associated with central nervous system and bone toxicity)
With new evidence from the package insert itself that the shot contains aluminum, there is clear evidence of danger.
From the insert:
WARNING: This product contains aluminum that may be toxic. Aluminum may reach toxic levels with prolonged parenteral administration if kidney function is impaired. Premature neonates are particularly at risk because their kidneys are immature, and they required large amounts of calcium and phosphate solutions, which contain aluminum. Research indicates that patients with impaired kidney function, including premature neonates, who receive parenteral levels of aluminum at greater than 4 to 5 mcg/kg/day accumulate aluminum at levels associated with central nervous system and bone toxicity. Tissue loading may occur at even lower rates of administration.
We don’t know which infants are most at risk (beyond preemies) when they’re minutes old. They don’t need aluminum-containing injections in their bodies, ever.
If you have any of the following risk factors, then you may want to consider it:
- Medication that reduces vitamin K levels (maternal)
- Liver disease (maternal or family history)
Only if there is a severe illness in mom or baby should it be considered? I had previously recommended that it be used in cases of gut dysbiosis, but upon the discovery of aluminum in the shot, I have amended that recommendation. I believe that the amount of aluminum is so harmful that it outweighs any potential benefits.
What Can I Do Instead of the Shot?
I would personally not choose either the shot or oral vitamin K (given my medical status). I don’t think that healthy, full-term babies should have higher levels of vitamin K. The levels are low for a reason and this should be left alone unless there is a specific risk factor present. Remember that although levels are low, clotting factors aren’t in most babies.
The thing is, these interventions — like the vitamin K shot — are great for people who do have specific risk factors and can help to prevent serious illnesses. But they’re just not needed for healthy babies with no risk factors. We need to be assessing people as individuals and figuring out what they need, rather than making a one-size-fits-all policy. There is nothing that is appropriate for all!
And we shouldn’t be scaring parents into making a decision without presenting them with all the facts. That’s just shady, in my opinion. That’s asking parents to just shut up and do what they’re told. If anyone ever says to you “Do this or your baby will die” (and it’s not a medical emergency-type situation) then say NO. You can always do some research and decide, later, to go ahead with the treatment with a more respectful doctor. But it should be an “absolutely not” answer to anyone who uses these types of scare tactics. I also recommend asking doctors like this to leave your room immediately and follow up by reporting them to the medical board for harassment. If you don’t hold them accountable, they will keep bullying parents.
There’s clearly a reason why babies have low levels of vitamin K in their first months of life, and we should be trying to figure out why rather than assuming they are “low” and supplemented babies are “normal.” By definition, if everyone “requires” a supplement then it is not normal! We could learn so much about how vitamin K works if we studied a population of healthy, exclusively breastfed infants…
If you do have a particular risk, then I would try some of the following.
Supplementing in Pregnancy
Supplement with vitamin K-rich foods in pregnancy, especially in the final weeks. Natto, gouda, Romano cheese, leafy greens, etc. Some herbs, like alfalfa, are also rich in vitamin K. This needs to be done at least every 1 – 3 days consistently to make a difference, for at least a few weeks before birth.
Supplementing While Breastfeeding
Same idea — continue supplementation through breastfeeding. I like to make an herbal tea which helps to balance hormones and which contains alfalfa.
Improve Gut Flora/Probiotic Supplements
Try a probiotic supplement to improve your gut flora and so that you are better able to absorb and synthesize vitamin K yourself. If you have any issues with digestion (stomach pains, gas, diarrhea, constipation, frequent indigestion), eczema, seasonal allergies, etc. then you can assume that your gut flora isn’t as healthy as it should be and that probiotic supplements would benefit you. This is best done starting early in pregnancy.
Consider Oral Supplements
If you know that you have minor risk factors (like serious gut flora issues, allergies, chronic diarrhea, etc.) then it may be wise to give the baby oral vitamin K. This needs to be done repeatedly, every few days through 6 weeks of age. One dose is not enough to prevent the serious late-onset VKDB.
If you know that your family is at serious risk because of a history of liver disease, if you had cholestasis in pregnancy, if you are on anti-convulsive medications — the vitamin K shot is probably necessary. Otherwise, it probably isn’t.