By Ally Kayton, DNP, APRN, NNP-BC, RMHI, IHP2
Founder, Sage & Stone Holistic Counseling & Integrative Health

As a Neonatal Nurse Practitioner, I have had the privilege of caring for thousands of newborns over the past two decades. One of the very first conversations we have with new parents after birth is about vitamin K.

For many families, it seems like a simple injection among many things happening during those first precious hours. For others, it has become a source of uncertainty after reading conflicting information online.

As parents, you deserve honest answers—not fear, pressure, or judgment.

My hope is that by understanding why vitamin K is recommended, you’ll feel empowered to make an informed decision for your baby.

Why Do Babies Need Vitamin K?

Vitamin K is an essential nutrient that allows our blood to clot normally. Without enough vitamin K, even a small amount of bleeding can become dangerous.

Every baby is born with naturally low vitamin K levels. This isn’t because something is wrong—it is simply part of newborn physiology.

Several factors contribute to these low levels:

• Very little vitamin K crosses the placenta during pregnancy.
• Newborns have not yet developed the healthy intestinal bacteria that eventually help produce vitamin K.
• Breast milk, while the ideal nutrition for babies, naturally contains only small amounts of vitamin K.

Because of this, every newborn enters the world with limited protection against serious bleeding.

What Is Vitamin K Deficiency Bleeding?

Vitamin K Deficiency Bleeding (VKDB) is a rare but potentially devastating condition that occurs when babies cannot form normal blood clots.

There are three forms:

Early VKDB occurs within the first 24 hours and is usually associated with certain maternal medications.

Classic VKDB develops during the first week of life and may cause bleeding from the umbilical cord, gastrointestinal tract, skin, or circumcision site.

Late VKDB is the form we worry about most. It occurs between one week and six months of age and often happens without warning.

Approximately 30–60% of babies with late VKDB present with bleeding into the brain.

Even more concerning:

• Approximately one in five affected infants dies.
• Many survivors experience permanent neurological injury.

The heartbreaking reality is that these outcomes are almost entirely preventable.

One Small Injection Makes an Enormous Difference

The vitamin K injection has been routinely recommended in the United States since 1961.

It is one of the most thoroughly studied newborn interventions in medicine.

Research estimates that babies who do not receive the vitamin K injection are approximately 81 times more likely to develop late vitamin K deficiency bleeding than babies who receive the standard intramuscular dose.

One injection provides reliable protection during the months before babies are able to maintain adequate vitamin K levels on their own.

Why Are More Parents Declining Vitamin K?

Recent research published in JAMA found that the percentage of newborns not receiving vitamin K nearly doubled between 2017 and 2024.

Many parents who decline are not neglectful—they are trying to make thoughtful decisions for their children. Unfortunately, today’s parents are navigating an overwhelming amount of misinformation, especially on social media.

Common concerns include:

• “Isn’t this unnatural?”
• “Does vitamin K cause cancer?”
• “What about preservatives?”
• “Can’t I just give it by mouth?”
• “I don’t want my baby to have unnecessary injections.”

These are understandable questions—and they deserve evidence-based answers.

Let’s Talk About the Most Common Questions

Does vitamin K cause cancer?

No.

This concern originated from a small study published more than 30 years ago that suggested a possible association with childhood leukemia.

Since then, numerous large, well-designed studies involving hundreds of thousands of children have found no evidence that vitamin K increases the risk of leukemia or any other cancer.

Today, every major pediatric organization continues to recommend routine vitamin K administration because the benefits overwhelmingly outweigh any theoretical risks.

Can my baby take vitamin K by mouth instead?

In some countries, oral vitamin K is used with multiple-dose schedules.

However, the American Academy of Pediatrics does not recommend oral vitamin K as an alternative because absorption is inconsistent, doses are often missed, and oral therapy does not reliably prevent late vitamin K deficiency bleeding.

The intramuscular injection provides the most dependable protection.

What about preservatives?

Some formulations contain very small amounts of preservatives, while many hospitals also offer preservative-free preparations.

The quantities used in a single newborn dose have not been shown to cause harm.

If preservatives are a concern, ask your hospital or birth center which formulation they use.

Doesn’t the shot hurt?

The injection is a brief pinch in your baby’s thigh.

As parents, we naturally want to prevent any discomfort for our children.

Fortunately, skin-to-skin contact, breastfeeding, and comforting immediately afterward help babies recover quickly.

The few seconds of discomfort provide months of protection against a potentially life-threatening condition.

Making an Informed Decision

As healthcare providers, our goal is never to pressure parents.

Our role is to provide accurate information, answer questions honestly, and help families make informed decisions based on the best available evidence—not fear or misinformation.

In my years caring for newborns, I have seen firsthand how quickly babies can become critically ill.

I have also seen the incredible impact that simple preventive measures—like vitamin K—have on keeping babies safe.

Sometimes the most powerful interventions in medicine are also the simplest.

A Final Thought

Parenthood begins with countless decisions.

Some are difficult.

Some have no clear right answer.

The vitamin K injection is one of the few interventions where decades of research consistently point in the same direction.

It is safe.

It is effective.

And it protects babies during one of the most vulnerable periods of life.

If you are expecting a baby and have questions about vitamin K, I encourage you to talk with your obstetric provider, pediatrician, midwife, or neonatal clinician. Asking questions is part of being an engaged parent—and those conversations matter.

At Sage & Stone, we believe that informed parents make confident decisions, and every family deserves compassionate, evidence-based guidance as they welcome a new life into the world.

References

Ardell, S., Offringa, M., Ovelman, C., & Soll, R. (2018). Prophylactic vitamin K for the prevention of vitamin K deficiency bleeding in preterm neonates. Cochrane Database of Systematic Reviews.

Centers for Disease Control and Prevention. (2013). Notes from the field: Late vitamin K deficiency bleeding in infants whose parents declined vitamin K prophylaxis—Tennessee, 2013. Morbidity and Mortality Weekly Report, 62(45), 901–902.

Coggins, S. A., Flannery, D. D., Mukhopadhyay, S., & Puopolo, K. M. (2026). Parental decline of newborn vitamin K and hepatitis B vaccine administration by newborn sex. JAMA Network Open.

Hand, I., Noble, L., & Abrams, S. A. (2022). Vitamin K and the newborn infant. Pediatrics, 149(3), e2021056036.

Schulte, R., Jordan, L. C., Morad, A., Naftel, R. P., Wellons, J. C., & Sidonio, R. F. (2014). Rise in late vitamin K deficiency bleeding in young infants because of omission or refusal of prophylaxis at birth. Pediatrics, 133(4), 630–636.

Scott, K., Miller, E., Culhane, J. F., et al. (2025). Trends in vitamin K administration among infants. Journal of the American Medical Association.