Predictably, when parents refuse evidence-based preventive health measures for their children, the diseases that those measures are meant to protect from increase. That is actually good confirmation that the preventive measures work. We are seeing that now with the increase in measles cases due entirely to anti-vaxxer propaganda, promoted by our own HHS secretary, which has increased vaccine refusal.
Two new studies published in JAMA journals now show that a recent increase in vitamin K refusal has lead to a surge in preventable bleeding events in infants.
Universal intramuscular vitamin K injections are recommended at birth, as an evidence-based, cost effective measure with high benefit in excess of risk. The evidence is overwhelming, and this really is an easy public-health call. Infants are relatively deficient in vitamin K, which does not cross the placenta well and exists in low levels in breast milk. Vitamin K is essential for the production of clotting factors, so the main risk is bleeding, including spontaneous bleeding. One shot of vitamin K at birth increases vitamin K level and is stored in the liver, providing adequate levels for the first six months of life, until dietary vitamin K can take over.
What is not to love about this health measure? It is entirely preventive, it does not involve any pharmaceuticals and is entirely nutrition-based, and it is highly effective. It can prevent catastrophic bleeds, including brain bleeds, in infants. One shot of intramuscular vitamin K at birth significantly reduces that risk (relative risk in that study was 0.19, with a number needed to treat of 74). Compliance is also very easy – it can happen automatically at birth, with no follow up.
Despite all this, about 3% of parents refuse the vitamin K shot. This figure can rise to 30% at birthing centers and with midwives. The first new study found: “In this cohort study of 5.2 million infants, nonreceipt of intramuscular vitamin K at birth increased from 3.1% in 2017 to 6.8% in 2025; bleeding within 6 months also increased. Nonreceipt of vitamin K was associated with significantly higher bleeding risk (288 vs 186 per 10 000 births) within 6 months.”
The second study found: “Between 2017 and 2025, the percentage of newborns who received injectable vitamin K decreased from 97.7% to 95.0%, and the rate of VKD and VKDB (vitamin K deficiency bleeding) at ages 0 to 6 months increased by 215.7% (from 11.8 [95% CI, 9.4-14.2] to 37.3 [95% CI, 34.4-40.3] per 100 000) and 347.1% (from 24.0 [95% CI, 20.6-27.4] to 107.4 [95% CI, 102.4-112.4] per 100 000), respectively.”
This roughly matches the data which shows decreased risk of bleeding with vitamin K – again, entirely predictable. So why are parents refusing this safe and effective natural preventive measure for their newborns? Based on parent interviews, four major themes emerge: the perception that the benefit is not worth the risk (it is not necessary), mistrust in the medical establishment, preference for more “natural” interventions, and prior bad experiences with hospitals and health care providers. None of these are good reasons.
The evidence is clear – the huge benefit is worth the tiny risk. It’s not even a close call. The notion that it is “not necessary” is often cited, because a newborn is healthy without bleeding risk. But this completely misunderstands the nature of preventive treatments and public health interventions. In some situations, universal prevention is the best approach. It is best at the individual and population level. By the time you know a bleeding event is happening, it’s too late. The damage is done, and it can be catastrophic. Spontaneous bleeding can happen in apparently perfectly healthy babies without any birth trauma.
The notion that other methods are more “natural” is based on nothing but a misguided world view and propaganda usually meant to sell snake oil to the public. Oral vitamin K is not as effective, and requires ongoing compliance so is less effective as a public health intervention. The mother increasing their vitamin K intake doesn’t help much, because little of it crosses the placenta. Why is that considered more “natural” anyway?
Critics of mainstream medicine falsely accuse doctors of neglecting preventive measures and nutrition. Here we have a preventive nutritional intervention – and the same contrarians are arguing that it is not necessary and not natural. This is an incoherent position.
It is unclear why we are seeing a recent increase in refusal of vitamin K but it may be due to the lack of trust factor. Vitamin K shots may be getting caught up in the backlash from COVID and the rise of antivaccine attitudes.
If you are a perspective parent, don’t listen to the noise on social media, don’t listen to the cranks and conspiracy theorists (which unfortunately includes the HHS secretary), but rather listen to the evidence and the medical logic. There is no reason not to give your child a vitamin K shot. It is a safe and effective preventive measure.
