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.
Why Your Newborn Needs a Vitamin K Shot
By: Ivan L. Hand, MD, MS, FAAP
There's a lot going on when your baby is first born. They're weighed and measured. Their noses are suctioned out and their vital signs are tested. They may have ointment or drops put in their eyes. They get a complete checkup by your pediatrician.
Most newborns get their first hepatitis B vaccine in the hospital. They also routinely get a vitamin K shot.
But what exactly is vitamin K, and do newborns really need it? Read on to learn more.
What does vitamin K do?
Vitamin K is a fat-soluble nutrient that helps our bodies make blood clots. We need blot clots to stop bleeding. Vitamin K is important for keeping bones healthy too.
Adults and older children get vitamin K from food such as green, leafy vegetables, meat, dairy, and eggs. The healthy bacteria in our intestines, which make up our microbiome, also produce some vitamin K.
Babies, though, have very little vitamin K in their bodies at birth. This puts them at risk for bleeding. Fortunately, it's easy to prevent VKDB with a vitamin K shot. The injection is given in your baby's thigh within 6 hours of birth.
One shot is all it takes to protect your baby from getting vitamin K deficiency bleeding. This is why, as pediatricians, we have recommended since 1961 that all newborns get a vitamin K shot at birth.
Why babies aren't born with enough vitamin K?
The two big reasons newborns need vitamin K:
They don't get much vitamin K from the mother during pregnancy. Unlike many other nutrients, vitamin K doesn't pass through the placenta very easily.
Babies' intestines don't have very many bacteria yet, so their bodies can't make enough vitamin K.
What is vitamin K deficiency bleeding?
Newborns who don't get a Vitamin K shot and are low on the vitamin are are at risk of vitamin K deficiency bleeding (VKDB). This happens when a baby's blood can't make clots, and their body can't stop bleeding.
The bleeding can happen on the outside of the body. It can also happen inside the body where parents can't see it. A baby could be bleeding into their intestines or brain before their parents know anything is wrong. Brain bleeding happens in about half of all babies who develop VKDB, and it can lead to brain damage or death.
There are three types of vitamin K deficiency bleeding:
Early-onset: This begins within the first 24 hours after birth. It usually happens when the mother is taking certain medications that interfere with vitamin K.
Classical: This happens between 2 days and 1 week after birth. Doctors don't know exactly what causes most of these cases. Early-onset and classical VKDB occur in 1 in 60 to 1 in 250 newborns.
Late-onset: This happens between 1 week and 6 months after birth. It's rarer than early-onset or classical VKDB, occurring in 1 in 14,000 to 1 in 25,000 babies. Infants who didn't get a vitamin K shot at birth are 81 times more likely to develop late-onset VKDB than babies who do get the shot.
Cases of VKDB seem to be increasing. This is partly because more parents are refusing the vitamin K shot for their newborns. VKDB is fairly rare, so many parents aren't aware of how dangerous the effects of this disease can be.
Are vitamin K shots safe?
Yes, vitamin K shots are very safe. The vitamin K from the injection is stored in your baby's liver and released slowly over months. This gives your baby the vitamin K they need until they can start getting it from solid food and making it themselves.
You may have heard about a study from the 1990s about a possible link between the vitamin K shot and developing childhood cancer. This didn't only worry parents; doctors and scientists were concerned too. Since then, experts have done many different kinds of studies to verify this link. None of the studies have ever been able to find that link again.
Can my newborn get oral vitamin K instead?
Some parents may ask for oral vitamin K instead of the shot. But babies can't absorb the oral form very well, so it doesn't work well to prevent VKDB. A vitamin K shot is the safest and best option for all newborns.
Does breastfeeding give my baby vitamin K?
Breast milk does give your baby a little bit of vitamin K. But it's not enough to prevent VKDB. Babies who are exclusively breastfed are at higher risk of developing VKDB because their vitamin K levels are low.
This all changes when your baby is old enough to start eating solid foods, usually between 4 and 6 months. The bacteria in your baby's intestines will also start making vitamin K once they're eating solid foods.
What are the signs of vitamin K deficiency bleeding?
In most cases, there aren't any warning signs to let you know beforehand that something serious—and possibly life-threatening—is happening.
When babies develop VKDB, they might have one or more of these signs:
Bleeding from the umbilical cord or nose
Paler skin or, in dark-skinned babies, pale gums
Bruising easily, especially around the face and head
Bloody stool or black, dark, sticky stool
A yellow tint to the white parts of the eyes 3 weeks or more after birth
Seizures, irritability, excessive vomiting, or sleeping too much
It's easy and safe to prevent VKDB with a vitamin K shot at birth. If you have any questions or concerns, be sure to talk to your pediatrician. They can help you weigh the benefits and risks.
Vitamin K and the Newborn Infant (AAP Policy Statement)
About Dr. Hand
Ivan L. Hand, MD, MS, FAAP, is Director of Neonatology, Kings County/Health & Hospitals and a Professor of Pediatrics at SUNY-Downstate School of Medicine. He was selected as a 2022 New York Super Doctor and is a member of the Society for Pediatric Research. Within the American Academy of Pediatrics (AAP), Dr. Hand is a member of the Committee on Fetus and Newborn.
The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.
How to survive the period between the first and second vaccinations against COVID-19
Recently, leaflets appeared in Yekaterinburg once again calling for people to refuse vaccination against coronavirus. We noticed them at the garbage sites, and these leaflets with dubious information did not cause much excitement. Including because life itself refutes speculation.
Vaccination is gaining momentum in all regions of the Ural Federal District. The number of those vaccinated in the Sverdlovsk region alone at the beginning of March reached 130 thousand people - and not a single serious complication. Another 62,000 signed up for the procedure. There is trust in the drug, as well as a desire to know what to expect from the vaccine.
Several correspondents of "RG", including the author of these lines, have checked for themselves how the vaccination changes the way of life that has developed over the past year. Initially, there were no problems with recording: they started early - at the end of 2020, so when the first batch of Sputnik V arrived in the region, invitations immediately followed. Honestly, I was worried, the pressure jumped, so much so that the doctor at the preliminary appointment almost turned back. That is, the therapist examines exactly not for show. I was helped to calm down, and pressure anxiety was the only annoyance associated with the first vaccination.
Taking a second dose of Sputnik V passed emotionally more calmly, but this time the temperature rose and lasted for about a day. The seal in the vaccination certificate stating that the vaccination had been passed helped to treat what was happening philosophically. It is too early to test for antibodies. And, according to experts, you should not rush. Why and how is it easier to survive the almost one-month period between the first and second vaccinations? We asked the chief epidemiologist of Yekaterinburg Alexander Kharitonov about all this.
Alexander Nikolayevich, doctors warn: before vaccination, you can not drink alcohol for three days, after vaccination, take a steam bath. Is it necessary to prepare the body in advance: take immunostimulants, vitamins? After all, stress…
Alexander Kharitonov: There is no need for special training. This is a common vaccination, as against any infectious diseases. The main thing is that the person at the time of vaccination is healthy, his chronic diseases do not worsen. If there is a tendency to allergic reactions, of course, it is better to consult with your doctor.
And my attitude to immunostimulants, to put it correctly, is not very good. I am sure: immunity must be maintained naturally. A person must fully eat, spend a lot of time in the fresh air, get enough sleep, and then the immune system will work. The same goes for vitamins. Now it is fashionable to take vitamin D. There is such an opportunity - take it, and it will not hurt before vaccination. But the same vitamin D is found in cod liver, vitamin A - in carrots.
Some doctors say that getting vaccinated in the middle of a pandemic is risky.
Alexander Kharitonov: There really is a danger of getting infected, because COVID-19 is transmitted by airborne droplets and you can catch the virus, especially if you ignore protective measures, at any time. More than one case is known when between the first and second vaccinations people fell ill with coronavirus. But, as practice has shown, they suffered the disease without serious problems. The production of antibodies in the body begins within a week after the first dose.
When does complete immunity to the virus appear? Made the second vaccination - and free as the wind?
Alexander Kharitonov: No, not free. Only three weeks after the second vaccination, the amount of antibodies necessary for complete protection is produced.
Do I need to take a test to confirm?
Alexander Kharitonov: The test is optional. In any case, antibodies will appear at the cellular level. Of course, no vaccine will protect one hundred percent. I repeat: a person who has been vaccinated, even if he gets sick, is not in a severe form, and most importantly, he will not die.
By some sensations, you can determine whether antibodies have been developed or not? I know people who have suffered even the first stage very hard. Young, vigorous...
Alexander Kharitonov: That's just the young react more sharply to the first stage - the body is struggling. On the second everything should be fine.
And if there were no complications during the entire period of vaccination, then antibodies will not appear?
Alexander Kharitonov: This means that everything went well, just the body did not react so violently. I, for example, neither after the first nor after the second did not record any side effects. Maybe there was a weakness, but I did not notice it, because I worked hard. However, antibodies have developed.
I know a person who did not have antibodies even one month after the second stage. They said he might be resistant to the vaccine. Is this good or bad? And what should he do: get vaccinated with another vaccine?
Alexander Kharitonov: There is no need to rush, let alone inject another drug. Antibodies may appear later. Again, the question arises about the quality of the test systems used. In the laboratory where you come for the study, be sure to say that you are conducting an analysis after vaccination and a quantitative method of determination is needed. In any case, the immune system of the vaccinated is already ready to meet with the coronavirus. She will see and react to the penetration of the pathogen.
Are there laboratories in Yekaterinburg where they test for antibodies for free?
Alexander Kharitonov: No.
Many people are sure that after vaccination one should stay at home for the first few days in order not to infect anyone…
Alexander Kharitonov: Nothing like that. All Russian coronavirus vaccines are based on a non-live virus. A person who has been given such a vaccine cannot be a source of infection. This version probably arose by analogy with the polio vaccine, where a live virus is used and during a certain period it is impossible to allow vaccinated and unvaccinated children to be together.
Do I need to notify my supervisor at work that you are being vaccinated?
Alexander Kharitonov: Nowhere is it written that it is necessary to inform the employer. Vaccination is an exclusively voluntary procedure. In my team I clearly know who has been ill, who has been vaccinated, who is going to vaccinate. I work with doubters. But no one will be expelled or punished for refusing to be vaccinated.
There is a lot of talk about herd immunity these days. They say the virus will stop spreading when 70 percent of people have antibodies. And in a particular work group?
Alexander Kharitonov: Collective immunity - when all 100 percent of employees have protective antibodies. Of course, teams are different. If ten thousand people work together, then 70 percent is enough. Well, if a couple of dozen, only one hundred percent protection is effective.
Why, after vaccination, keep a diary of your well-being on the public services portal?
Alexander Kharitonov: To account for rare reactions, possible complications, receive recommendations, and so on. In addition, if you are registered on the portal, the vaccination data is entered into the federal register, and after the second vaccination you will receive a certificate with a code that can be printed out and provided as a supporting document. Anyone who does not use the site is stamped in a regular vaccination certificate and certified with the seal of a medical institution.
The introduction of special documents - covid-passports - is now being actively discussed, so that they give greater freedom of movement. Do you think such a document is necessary?
Alexander Kharitonov: No. A regular vaccination certificate is sufficient.
Anna Tkach, clinical psychologist, head of the counseling and health department of the Yekaterinburg City Center for Medical Prevention:
- First, realize why you need to get vaccinated, that is, motivate yourself. Traditional arguments: I want to stop being afraid of getting sick, protect my own health and my loved ones from infection, expand the opportunities for visiting cinemas, museums or traveling to other countries.
When you have found the reasons, try to understand what prevents you from getting vaccinated. Most likely, fears will emerge that, if you look closely, have no basis. We do not take into account contraindications to vaccination, but consider only anxiety without apparent reason: fear of fever, complications of chronic diseases. Finding out the cause of fears, try to prevent them. For example, buy in advance medicine to reduce the temperature.
So, after talking to yourself, you can come to the conclusion that there are no grounds for refusing vaccination. And there are myths, information on the Internet, which easily unbalances us. Study positive experience, reliable information and trust yourself.
In modern conditions of life in a metropolis, there is almost always a real possibility of a rapid spread of pathogens of various infections, both among adults and among children. The most reliable and time-tested means of preventing infectious diseases is vaccination. The effectiveness of vaccination is universally recognized throughout the world. With the help of vaccination, it is possible to prevent a significant number of deaths every year and save up to 4.5 million human lives.
The choice of vaccination concerns each of us and literally immediately with the advent of a new family member. Protecting your children from deadly infections, understanding the importance of vaccination, is the responsibility of every parent.
Influenza is an acute seasonal viral disease. Influenza epidemics occur every year, usually during the cold season, and affect up to 15% of the world's population. Influenza and SARS account for 95% of all infectious diseases in the world. Every year, up to 500 million people fall ill in the world, 2 million of whom die. The most effective way to fight the flu is to get vaccinated.
You can get the flu vaccination:
Polyclinic department No. 4
Polyclinic department №53
Children's polyclinic department No. 1
The choice of vaccination concerns each of us and literally immediately with the advent of a new family member. Protecting your children from deadly infections, understanding the importance of vaccination, is the responsibility of every parent.
Different countries have their own national vaccination schedules. In Russia, such a calendar provides for the mandatory protection of children against 12 infectious diseases: hepatitis B, tuberculosis, polio, whooping cough, diphtheria, tetanus, measles, mumps, rubella, influenza, pneumococcal infection, hemophilic infection (for children at risk). It is also advisable to protect the baby from meningococcal infection (from 1.5 years), from hepatitis A (after 1 year), chicken pox (from 12 months), rotavirus infection (from 7 weeks of age). It is especially important to be vaccinated before visiting preschool institutions, in preparation for trips abroad, as well as frequently ill children and patients with chronic somatic diseases.
There are several rules for preparing a child for vaccination:
- At the time of vaccination, the child must be healthy, have a normal temperature, a few days before vaccination, the environment and diet of the child should not be changed.
- 2-3 days before and after vaccination, do not take your baby to visits and events where there are a large number of people.
- If there are manifestations of an allergy, then the vaccination can be done only when there have been no new rashes for three weeks. If you give your child vitamin D, then to prevent allergic reactions, it is better to stop taking it 3 days before vaccination and resume no earlier than 5 days later. It does not hurt to give calcium to the child 3 days before and after vaccination.
- The day before vaccination, on the day of vaccination and the next day - limit the amount and concentration of food eaten if possible. With natural feeding, there are usually no problems - breast milk itself is an excellent prevention of post-vaccination reactions.
When vaccinating your children, do not forget about yourself. Not everyone remembers that every adult should be vaccinated against diphtheria and tetanus every 10 years; annually for the flu. Influenza vaccination is especially indicated for the elderly, as it reduces the incidence and mortality from heart attack, stroke, coronary heart disease, and prevents the exacerbation of various chronic diseases.
Young women who have not had rubella and chicken pox and have not been vaccinated before, to have a healthy baby, should be vaccinated against these diseases in advance. After all, the transferred chicken pox or rubella during the entire period of waiting for the baby can cause serious complications with the development of congenital deformities. Young people who did not have mumps and were not vaccinated against the infection as children should also be vaccinated against the infection, which can lead to male infertility. In addition, given the high prevalence, carriage and presence of latent forms of hepatitis A and B, it is advisable to vaccinate against these infections for all people.