Newborn Vitamin K Shot Refusals Increase, Raising Bleeding Concerns

Key Highlights

• The vitamin K injection helps protect newborns from potentially fatal bleeding during the first 6 months of life, when vitamin K levels may remain low.
• Vitamin K deficiency bleeding can occur within the first 24 hours or emerge weeks to months later, sometimes presenting only after intracranial bleeding, seizures, or neurological injury has occurred.
• Clinicians can address hesitancy by understanding the information parents encounter, explaining the evidence without judgment, and building trust through empathetic, direct communication.

Consultant360 spoke with John W. Harrington, MD, Vice President of Quality, Safety, and Clinical Integration, Children's Hospital of The King's Daughters in Norfolk, VA, and Consultant360 Pediatrics Section Editor, about a Reuters analysis that found the proportion of US newborns who did not receive a vitamin K injection within 1 day of birth increased by more than 57% from January through June 2026. According to the report, based on health records from more than 1 million births, the rate reached 8.1% in June, up from 5.2% at the end of 2025. The rate during the first half of 2026 was also 2.5 times the average recorded from 2019 through 2024.

In this Q&A, Dr Harrington discusses the clinical implications of this trend, the consequences of vitamin K deficiency bleeding, and how clinicians can communicate more effectively with parents and caregivers who are considering refusing the injection.

Additional Resources: Steenhuysen J. US refusals of crucial newborn vitamin spike, raising risk of dangerous bleeding. Reuters. Published September 1, 2026. Accessed September 3, 2026. https://www.reuters.com/world/us/refusals-crucial-newborn-vitamin-spike-raising-risk-dangerous-bleeding-2026-09-01/

Consultant360: Reuters reported that the rate of newborns not receiving a vitamin K injection within 1 day of birth increased by more than 57% from January through June 2026. What is the clinical significance of this increase?

Dr Harrington: Vitamin K refusal used to be extremely rare, but we are beginning to see the ripple effects of more newborns not receiving vitamin K and other recommended interventions after birth. Infants may leave the nursery without protection against conditions that could cause serious illness or death.

They then come to the private pediatrician’s office, and in some cases, the parents say, “Can I get it now?” We do not usually carry vitamin K in our offices. We can administer it later, but we have already missed the period immediately after birth when the child could experience a significant brain bleed. I would still recommend giving it at that point to reduce the risk of a later complication related to vitamin K deficiency.

Because of this trend, I oversee primary care practices in our area, and we have advised them to keep the 1-mg vitamin K injection available. The practice may have to absorb the cost if it is not used before the end of its shelf life, but we want to be able to intervene if a parent reconsiders.

Parents may be receiving or reading information about newborn care that is not entirely accurate. What we know is that infants who do not receive vitamin K are much more likely to develop vitamin K deficiency and a related bleeding disorder. That bleeding can cause death or neurological impairment that lasts for the rest of the child’s life.

Some parents may say that they are willing to take that risk. As pediatricians, we do not want that risk taken on behalf of the child. However, parents can make decisions about their child’s care. Our role is to educate them. I do not want to have a political argument with a parent. I want to explain what we do, why we do it, and how we use the available evidence to protect children.

Consultant360: What protection does the vitamin K injection provide, and what can happen when a newborn does not receive it?

Dr Harrington: The injection increases the newborn’s vitamin K level and helps protect the infant from bleeding during the first 6 months of life.

Some infants may be born with especially low vitamin K levels. For example, certain medications taken during pregnancy, including some antiseizure medications and blood thinners, may reduce the mother’s vitamin K levels, which could affect the infant’s levels at birth.

Breastfeeding is something we want to encourage, but breast milk does not provide as much vitamin K as an infant may need. Even when a parent is doing the right thing by breastfeeding, the infant’s vitamin K level can decline more quickly. Without supplementation, that can place the child at risk for a bleeding disorder.

The injection is the best way to provide that supplementation because it can be given as a single dose. An alternative approach requiring a parent to administer vitamin K repeatedly may not be as reliable as providing the full intervention at birth. We would rather protect the infant at that moment than depend on repeated treatment over time.

This issue also gives us an opportunity to help parents understand what we are doing. In pediatrics, the system has historically been focused on treating the child because we want to do what is best for the child. We may not always have done a good enough job of explaining each intervention to the parent along the way.

Medicine can move faster than our efforts to educate patients and families. We need to explain more clearly why the vitamin K injection is given and what it prevents so parents can make an informed decision.

Consultant360: How soon after birth can vitamin K deficiency bleeding occur, and can some cases initially be difficult for parents or clinicians to recognize?

Dr Harrington: It can occur within the first 24 hours, but it can also take weeks or months to become apparent. That is why the risk does not disappear simply because the child seemed well immediately after birth.

When an infant has not received the injection, we have to remain concerned about vitamin K deficiency bleeding. A parent may think, “The baby is fine now,” but the child is not necessarily free from risk. The condition can present later.

An infant can experience bleeding in the brain before the problem is recognized. A parent may initially notice that the child is twitching or having seizure-like activity. By that point, the child may already have intracranial bleeding, seizures, and irreversible neurological injury.

That delayed presentation is one of the difficult aspects of vitamin K deficiency bleeding. The infant can appear well until a serious event has already occurred.

Consultant360: Are pediatricians and newborn-care teams seeing changes in the frequency of refusals?

Dr Harrington: It used to be fairly rare. Now, clinicians working in a busy nursery may encounter someone declining vitamin K once a week or once a month.

The refusal also sometimes coincides with a parent declining the hepatitis B vaccine. The hepatitis B vaccine can help prevent transmission to the infant if the mother has hepatitis B, including in circumstances in which an infection may not yet have been identified through blood work.

When parents decline vitamin K and hepatitis B vaccination at birth, it may also indicate that they plan to refuse other childhood immunizations. The concern then extends beyond the immediate risk of vitamin K deficiency bleeding. The child may remain susceptible to infections that recommended immunizations could help prevent.

We have to become better communicators and respond to claims that vaccines and other newborn interventions are unsafe. It can be difficult to find common ground with parents who have repeatedly encountered that message, but we still need to find a place where a productive discussion can begin.

Consultant360: What misconceptions or safety concerns appear to be contributing to refusals?

Dr Harrington: Clinicians need to understand the information parents are encountering. I teach residents and medical students, and I have challenged them to observe how social media algorithms work. If you begin searching for content about vaccine hesitancy, complications, or adverse outcomes, the platform will continue feeding you similar material.

It can become a self-fulfilling process. If everything a person sees makes the same claim, the issue begins to appear universal. Repeated exposure can make the claim feel true.

That is why clinicians should occasionally examine the information on the other side of the discussion. We need to know what parents are hearing. There may be a small element of truth within a claim, but it may not represent the complete truth or may be missing essential context.

For example, parents may hear that some Scandinavian countries use oral vitamin K rather than the injection. That is true in certain settings, but oral vitamin K requires multiple doses at specific intervals to raise and maintain the infant’s levels.

We could consider a similar approach here, but it would require substantial changes. Parents may face costs, insurers may not cover the medication, and families may have difficulty returning for follow-up appointments or obtaining transportation. Even with an oral regimen, some children may not receive all the necessary doses and could remain at risk for serious bleeding.

Practices in other countries may operate within different health care systems in which everyone has coverage and reliable access to follow-up care. A fact from one setting cannot simply be transferred to another without considering those differences. Research would also be needed to determine how well an alternative approach would work in the United States.

Clinicians may also encounter suspicions that interventions are recommended primarily for financial reasons or because health care professionals are influenced by pharmaceutical companies. Those beliefs can make communication difficult. We have to respond with evidence and explain the clinical reasoning behind our recommendations.

Consultant360: How should clinicians address these concerns without alienating parents?

Dr Harrington: The goal should not be to win an argument. It should be to understand what the parent believes, explain the evidence, and describe the potential consequences for the child.

Parents love their children and want to do what is right for them. I try not to misjudge a parent or approach the conversation in a way that feels judgmental. I want to tell them what is supported by evidence and what I believe is the best option for their child.

If that is not what they choose, I have to accept their decision and continue moving forward with the family. Preserving the relationship gives us additional opportunities to discuss the issue and may allow the parent to reconsider.

Consultant360: If refusal rates continue to rise, what effects could pediatric practices, hospitals, and health systems expect?

Dr Harrington: If we stopped routinely administering vitamin K, we would begin seeing more brain bleeds and neurological injuries across the country. People would ask why these events were occurring, and the answer would be that we had removed an intervention that was preventing them.

When you take away an effective safeguard, the complications it prevented begin to reappear. We see a similar principle when vaccination rates decline and diseases such as measles return. People may be surprised that measles can cause death, but preventing those outcomes is why the vaccine was recommended in the first place.

There are also practical consequences for pediatric practices. As more parents initially refuse vitamin K and then reconsider, offices may need to stock the injection even if it has not traditionally been kept in primary care settings.

The broader pattern of declining recommended preventive interventions can also affect how clinicians evaluate children. If a child has not received recommended immunizations and later presents with a fever or other symptoms, the parent may be more worried and seek care in an emergency department or urgent care center. Clinicians may need to perform additional blood work, a lumbar puncture, or other tests because the child does not have the expected protection against certain diseases.

Those results may ultimately be negative, which is reassuring, but the testing was still necessary because the child’s risk profile was different. Clinicians are placed in the difficult position of respecting decisions that parents are permitted to make while also doing additional work to ensure that the child is safe.

Better communication and greater understanding would help. Our responsibility is to provide parents with accurate information, explain the evidence, and recommend the option most likely to protect the child.

This Q&A has been edited for length and clarity.

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