TABLE 2

Reasons for Refusal of Intramuscular Vitamin K by Parents of Infants

Authors, CountryStudy Type and ParticipantsReasons for Refusal of IM Vitamin K
Marcewicz et al,3 United StatesTelephone interviews of 74 parents who refused intramuscular vitamin K for their newbornsParent’s perception that intramuscular vitamin K is not necessary (53%); parents desired natural birthing process (36%); concern about preservatives or ingredients (19%); concern about adverse reactions (14%); concern about harmful effect of pain for infant (11%); concern about dose being too high (11%); concern that injection causes cancer (8%); concern about potentially overwhelming infant’s immune system (1%)
Hamrick et al,4 United StatesCross-sectional survey of 54 parents who refused intramuscular vitamin K for their newbornsConcern about synthetic or toxic materials (37%); concern about excessive dose (28%); concern about side effects (24%); preference for natural sources of vitamin K (24%); views as unnecessary or no benefit (21%); concern about pain (13%); personal reason (11%); religious reason (11%); concern about cancer (7%)
Loyal et al,5 United StatesCross-sectional survey of 85 newborn nursery directors in a national network of newborn nurseriesParents’ perceptions that intramuscular vitamin K is unnecessary (69%); lack of knowledge regarding the role of intramuscular vitamin K in preventing VKDB (69%); concern about preservatives in the intramuscular injection (53%); concern about damaging effects of pain from injection (51%); concern about the association of intramuscular vitamin K with leukemia (32%); perception that vitamin K is a vaccine (31%); perception that dose of intramuscular vitamin K is too high (12%)
Centers for Disease Control and Prevention,16 United StatesCase report of 4 infants with late-onset VKDB who did not receive intramuscular vitamin K because of refusal by parentConcern about an increased risk for leukemia; impression that the injection was unnecessary; desire to minimize their infant’s exposure to “toxins”
Miller et al,17 New ZealandQualitative study of 15 parents who refused intramuscular vitamin K for their newbornsParents’ beliefs and values: preference for alternative or natural lifestyle; questioning of mainstream medicine or science; religious reasons
Child welfare: perceived risk outweighs benefits; amount given via intramuscular; changing mind depending on outcomes
External influences: Health care professionals; information sources; celebrities; family; friends
Weddle et al,18 United StatesCase report of a newborn whose parents refused intramuscular vitamin KConcern about dose being too high; concern about pain from injection and a potential entry for germs; concern about metal and preservatives in the injection; oral vitamin K was recommended by a chiropractor
Levin et al,19 United StatesCase reports of 6 infants who did not receive intramuscular vitamin K because of refusal by parentParents identified with an alternative lifestyle; religious reason; concern about harm from “toxic ingredients” in injection; wanting to be “natural”; and desire to delay shots
Eventov-Friedman et al,20 IsraelSurvey of a convenience sample of 217 expectant parentsOf parents who were not sure or not intending to give their newborns intramuscular vitamin K, perceptions were influenced by recommendations from the pediatrician, spiritual leaders, family members, friends, and the Internet; some parents were concerned about pain from the injection, and some parents were opposed to “medications” or immunizations and injections
Loyal et al,61 United StatesQualitative study of 19 parents who refused intramuscular vitamin K for their newbornsRisk/benefit ratio: parents who refused intramuscular vitamin K perceived risk to their newborns from preservatives, for example
“Natural” approaches: leading to seeking oral vitamin K or increasing the mother’s own prenatal dietary vitamin K intake
Placement of trust and mistrust: mistrust of the medical and pharmaceutical community with overlapping concerns about vaccines and trust of self, likeminded allopathic and nonallopathic health care providers, the social circle, the Internet, and social media
Informed by experiences: includes hospital experiences with previous pregnancies and communication with health care providers