Vitamin K is a substance that our body needs to form clots and to stop bleeding. We get vitamin K from the food we eat. Some vitamin K is also made by the good bacteria that live in our intestines. Babies are born with very small amounts of vitamin K stored in their bodies, which can lead to serious bleeding problems if not supplemented.

Vitamins

• Vitamins are substances our bodies need, which we get from either the foods we eat or from a multivitamin.
• Vitamins are normally stored in the body. A person without enough of a vitamin stored in the body is “vitamin deficient” or has a “vitamin deficiency”.

Since 1961, the American Academy of Pediatrics has recommended supplementing low levels of vitamin K in newborns with a single shot of vitamin K given at birth. Low levels of vitamin K can lead to dangerous bleeding in newborns and infants. The vitamin K given at birth provides protection against bleeding that could occur because of low levels of this essential vitamin.

Below are some commonly asked questions and their answers. If you continue to have concerns about vitamin K, please talk to your pediatrician or healthcare provider.

Q: What is vitamin K, and how do low levels of vitamin K and vitamin K deficiency bleeding occur in babies?

A: Vitamin K is used by the body to form clots and to stop bleeding. Babies are born with very little vitamin K stored in their bodies. This is called “vitamin K deficiency” and means that a baby has low levels of vitamin K. Without enough vitamin K, babies cannot make the substances used to form clots, called ‘clotting factors.’ When bleeding happens because of low levels of vitamin K, this is called “vitamin K deficiency bleeding” or VKDB. VKDB is a serious and potentially life-threatening cause of bleeding in infants up to 6 months of age. A vitamin K shot given at birth is the best wayto prevent low levels of vitamin K and vitamin K deficiency bleeding (VKDB).

Q: Why do ALL babies need a vitamin K shot – can’t I just wait to see if my baby needs it?

A: No, waiting to see if your baby needs a vitamin K shot may be too late. Babies can bleed into their intestines or brain where parents can’t see the bleeding to know that something is wrong. This can delay medical care and lead to serious and life-threatening consequences. All babies are born with very low levels of vitamin K because it doesn’t cross the placenta well. Breast milk contains only small amounts of vitamin K. That means that ALL newborns have low levels of vitamin K, so they need vitamin K from another source. A vitamin K shot is the best way to make sure all babies have enough vitamin K. Newborns who do not get a vitamin K shot are 81 times more likely to develop severe bleeding than those who get the shot.

Q: Doesn’t the risk of bleeding from low levels of vitamin K only last a few weeks?

A:No, VKDB can happen to otherwise healthy babies up to 6 months of age. The risk isn’t limited to just the first 7 or 8 days of life and VKDB doesn’t just happen to babies who have difficult births. In 2013, the Centers for Disease Control and Prevention (CDC) investigated 4 cases of infants with bleeding from low levels of vitamin K. All four were over 6 weeks old when the bleeding started and they had been healthy and developing normally. None of them had received a vitamin K shot at birth.

Q: Isn’t VKDB really rare?

A: VKDB is rare in the United States, but only because most newborns get the vitamin K shot. Over the past two decades, many countries in Europe have started programs to provide vitamin K at birth – afterward, they all saw declines in the number of cases of VKDB to very low levels. However, in areas of the world where the vitamin K shot isn’t available, VKDB is more common, and many cases of VKDB have been reported from these countries

In the early 1980s in England, some hospitals started giving vitamin K only to newborns that were thought to be at higher risk for bleeding. They then noticed an increase in cases of VKDB. This tells us that giving vitamin K to prevent bleeding is what keeps VKDB a rare condition – when vitamin K is not given to newborns, cases of bleeding occur and VKDB stops being rare.

Q: What happens when babies have low levels of vitamin K and get VKDB?

A: Babies without enough vitamin K cannot form clots to stop bleeding and they can bleed anywhere in their bodies. The bleeding can happen in their brains or other important organs and can happen quickly. Even though bleeding from low levels of vitamin K or VKDB does not occur often in the United States, it is devastating when it does occur. One out of every five babies with VKDB dies. Of the infants who have late VKDB, about half of them have bleeding into their brains, which can lead to permanent brain damage. Others bleed in their stomach or intestines, or in other parts of the body. Many of the infants need blood transfusions, and some need surgeries.

Q: I heard that the vitamin K shot might cause cancer. Is this true?

A: No. In the early 1990s, a small study in England found an “association” between the vitamin K shot and childhood cancer. An association means that two things are happening at the same time in the same person, but doesn’t tell us whether one causes the other. Figuring out whether vitamin K might cause childhood cancer was very important because every newborn is expected to get a vitamin K shot. If vitamin K was causing cancer, we would expect to see the same association in other groups of children. Scientists looked to see if they could find the same association in other children, but this association between vitamin K and childhood cancer was never found again in any other study.

Q: Can the other ingredients in the shot cause problems for my baby? Do we really know that the vitamin K shot is safe?

A: Yes, the vitamin K shot is safe. Vitamin K is the main ingredient in the shot. The other ingredients make the vitamin K safe to give as a shot. One ingredient keeps the vitamin K mixed in the liquid; another keeps the liquid from being too acidic. One of the ingredients is benzyl alcohol, a preservative. Benzyl alcohol is a common ingredient in many medications.

In the 1980s, doctors recognized that very premature infants who were in neonatal intensive care units might become sick from benzyl alcohol toxicity because many of the medicines and fluids needed for their intensive care contained benzyl alcohol as a preservative. Although the toxicity was only reported for very premature infants, since then doctors have tried to minimize the amount of benzyl-alcohol-containing medications they give. Clearly, the small amount of benzyl alcohol in the vitamin K shot is not enough to be dangerous, even when given in combination with other medications that also contain small amounts of this preservative.

Q: The dose of the shot seems high. Is that too much for my baby?

A: No, the dose in the vitamin K shot is not too much for babies. The dose of vitamin K in the shot is high compared to the daily requirement of vitamin K. But remember babies don’t have much vitamin K when they are born and won’t have a good supply of vitamin K until they are close to six months old. This is because vitamin K does not cross the placenta and breast milk has very low levels of vitamin K.

The vitamin K shot acts in two ways to increase the vitamin K levels. First, part of the vitamin K goes into the infant’s bloodstream immediately and increases the amount of vitamin K in the blood. This provides enough vitamin K so that the infant’s levels don’t drop dangerously low in the first few days of life. Much of this vitamin K gets stored in the liver and it is used by the clotting system. Second, the rest of the vitamin K is released slowly over the next 2-3 months, providing a steady source of vitamin K until an infant has another source from his or her diet.

Q: Can I increase vitamin K in my breast milk by eating different foods or taking multivitamins or vitamin K supplements?

A: We encourage moms to eat healthy and take multivitamins as needed. Although eating foods high in vitamin K or taking vitamin K supplements can slightly increase the levels of vitamin K in your breast milk, neither can increase levels in breast milk enough to provide all of the vitamin K an infant needs.

When infants are born, their already low levels of vitamin K fall even lower. Infants need enough vitamin K to (a) make up for their extra-low levels, (b) start storing it in the liver for future use, and (c) ensure good bone and blood health. Breast milk – even from mothers supplementing with vitamin K sources – can’t provide enough to do all of these things.

Q: My baby is so little. What can I do to make the vitamin K shot less painful and traumatic?

A: Babies, just like us, feel pain, and it is important to reduce even small amounts of discomfort. Babies feel less pain from shots if they are held and allowed to suck.You can ask to hold your baby while the vitamin K shot is given so that your baby can be comforted by you. Breastfeeding while the shot is given and immediately after can be comforting too. All of these are things parents can do to ease pain and soothe their baby.

Remember that if your baby does not get the vitamin K shot, his or her risk of developing severe bleeding is 81 times higher than if he or she got the shot. Diagnosis and treatment of VKDB often involves many painful procedures, including repeated blood draws.

Q: Overall, what are the risks and benefits of the vitamin K shot?

The risks of the vitamin K shot are the same risks that are part of getting most any other shot. These include pain or even bruising or swelling at the place where the shot is given. A few cases of skin scarring at the site of injection have been reported. Only a single case of allergic reaction in an infant has been reported, so this is extremely rare.

Although there have been concerns about some other risks, like a risk for childhood cancer or risks because of additional ingredients, none of these risks have been proven by scientific studies.

The main benefit of the vitamin K shot is that it can protect your baby from VKDB, a dangerous condition that can cause long-term disability or death. In addition, the diagnosis and treatment of VKDB often includes multiple and sometimes painful procedures, such as blood draws, CT scans, blood transfusions, or anesthesia and surgery.

The American Academy of Pediatrics has recommended the Vitamin K shot since 1961, and has repeatedly stood by that recommendation because the risks of the shot don’t outweigh the risks of VKDB, which are based on decades of evidence and decades of experience with babies who were hospitalized or died from VKDB.

Your child’s doctor is the best person to talk to about vitamin K. Like you, your child’s doctor wants to see your children grow up safe and healthy and wants to support your efforts to make the best decisions for their health. If you have concerns about vitamin K, talk to your child’s doctor.

Vitamin K deficiency bleeding or VKDB, occurs when babies cannot stop bleeding because their blood does not have enough Vitamin K to form a clot. The bleeding can occur anywhere on the inside or outside of the body. When the bleeding occurs inside the body, it can be difficult to notice. Commonly, a baby with VKDB will bleed into his or her intestines, or into the brain, which can lead to brain damage and even death. Infants who do not receive the vitamin K shot at birth can develop VKDB at any time up to 6 months of age. There are three types of VKDB, based on the age of the baby when the bleeding problems start: early, classical and late.

All infants, regardless of sex, race, or ethnic background, are at higher risk for VKDB until they start eating regular foods, usually at age 4-6 months, and until the normal intestinal bacteria start making vitamin K. This is because:

• At birth, babies have very little vitamin K stored in their bodies because only small amounts pass to them through the placenta from their mothers.
• The good bacteria that produce vitamin K are not yet present in the newborn’s intestines.
• Breast milk contains low amounts of vitamin K, so exclusively breastfed babies don’t get enough vitamin K from the breast milk, alone.

The good news is that VKDB is easily prevented by giving babies a vitamin K shot into a muscle in the thigh. One shot given just after birth will protect your baby from VKDB. In order to provide for immediate bonding and contact between the newborn and mother, giving the vitamin K shot can be delayed up to 6 hours after birth.

Yes. Many studies have shown that vitamin K is safe when given to newborns.

Some things can put infants at a higher risk for developing VKDB. Babies at greater risk include:

• Babies who do not receive a vitamin K shot at birth. The risk is even higher if they are exclusively breastfed.
• Babies whose mothers used certain medications, like isoniazid or medicines to treat seizures. These drugs interfere with how the body uses vitamin K.
• Babies who have liver disease; often they cannot use the vitamin K their body stores.
• Babies who have diarrhea, celiac disease, or cystic fibrosis often have trouble absorbing vitamins, including vitamin K, from the foods they eat.

Since babies can be affected until they are 6 months old, healthcare providers divide VKDB into three types; early, classical and late. The chart below helps explain these three different types.

• Early and classical VKDB are more common, occurring in 1 in 60 to 1 in 250 newborns, although the risk is much higher for early VKDB among those infants whose mothers used certain medications during the pregnancy.
• Late VKDB is rarer, occurring in 1 in 14,000 to 1 in 25,000 infants.
• Infants who do not receive a vitamin K shot at birth are 81 times more likely to develop late VKDB than infants who do receive a vitamin K shot at birth.

Unfortunately, in the majority of cases of VKDB, there are NO WARNING SIGNS before a life-threatening event starts.  Babies with VKDB might develop any of the following signs:

• Bruises, especially around the baby’s head and face
• Bleeding from the nose or umbilical cord
• Skin color that is paler than before.  For darker skinned babies, the gums may appear pale
• After the first 3 weeks of life, the white parts of your baby’s eyes may turn yellow.
• Stool that has blood in it, is black or dark and sticky (also called ‘tarry’), or vomiting blood
• Irritability, seizures, excessive sleepiness, or a lot of vomiting may all be signs of bleeding in the brain

Remember, VKDB is easily preventable with just a single vitamin K shot at birth.

Protect Your Baby from Vitamin K Deficiency Bleeding

Before having a baby, most parents don’t give much thought to the vitamin K injection (shot) for their newborn. It’s just not something that is talked about during prenatal checkups, even though babies have been routinely given this important shot at birth since the practice was first recommended by the American Academy of Pediatrics in 1961.

Vitamin K is needed for blood to clot normally. Babies are born with very small amounts of vitamin K in their bodies which can lead to serious bleeding problems. Research shows that a single vitamin K shot at birth protects your baby from developing dangerous bleeding which can lead to brain damage and even death. Ask your healthcare provider about the benefits of Vitamin K before your delivery. Protect your newborn by making sure he or she gets the shot after birth.

What is vitamin K deficiency bleeding (VKDB)?

Vitamin K deficiency bleeding or VKDB, is a condition that occurs when the baby does not have enough Vitamin K.

Without enough vitamin K, your baby has a chance of bleeding into his or her intestines, and brain, which can lead to brain damage and even death. Infants who do not receive the vitamin K shot at birth can develop VKDB up to 6 months of age.

How can I prevent VKDB?

The good news is that VKDB is easily prevented. The easiest and most reliable way to give babies vitamin K is by a shot into a muscle in the leg. One shot given after birth will protect your baby from VKDB.

What are the warning signs of VKDB?

In the majority of cases of VKDB, there are NO WARNING SIGNS at all before a life-threatening bleed starts. Babies who do not get a vitamin K shot at birth might develop any of these signs of VKDB:

• Easy bruising especially around the baby’s head and face
• Bleeding from the nose or umbilical cord
• Paler than usual skin color or, for dark skinned babies, pale appearing gums
• Yellow eyes after the baby is 3 weeks old
• Blood in the stool, black tarry stool, or vomiting blood
• Irritability, seizures, excessive sleepiness, or a lot of vomiting may all be signs of bleeding in the brain

Did You Know?

About half of all babies who develop VKDB bleed into their brains.

Is Vitamin K safe?

A study from the early 1990’s found a possible link between getting vitamin K and developing childhood cancer. Pediatricians became very concerned about this and have done many studies since then, in many different ways, trying to see if this link was true. None of the studies found this link again, even though doctors and scientists looked very hard for it.

Does my baby get vitamin K from breast milk?

Yes, but not enough to prevent VKDB. There is only a little vitamin K in breast milk. Breastfed babies are low in vitamin K for several weeks until they start eating regular foods, usually at 4-6 months, and until the normal intestinal bacteria start making vitamin K.

Should all babies get a vitamin K shot at birth?

Yes. Babies do not have enough vitamin K at birth and are, therefore, at risk for having serious bleeding. Thus, it is very important that all babies get a vitamin K shot to prevent VKDB.