TABLE 2.
Reasons for Refusal of Intramuscular Vitamin K by Parents of Infants
| Authors, Country | Study Type and Participants | Reasons for Refusal of IM Vitamin K |
|---|---|---|
| Marcewicz et al,3 United States | Telephone interviews of 74 parents who refused intramuscular vitamin K for their newborns | Parent’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 States | Cross-sectional survey of 54 parents who refused intramuscular vitamin K for their newborns | Concern 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 States | Cross-sectional survey of 85 newborn nursery directors in a national network of newborn nurseries | Parents’ 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 States | Case report of 4 infants with late-onset VKDB who did not receive intramuscular vitamin K because of refusal by parent | Concern 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 Zealand | Qualitative study of 15 parents who refused intramuscular vitamin K for their newborns | Parents’ 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 States | Case report of a newborn whose parents refused intramuscular vitamin K | Concern 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 States | Case reports of 6 infants who did not receive intramuscular vitamin K because of refusal by parent | Parents 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 Israel | Survey of a convenience sample of 217 expectant parents | Of 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 States | Qualitative study of 19 parents who refused intramuscular vitamin K for their newborns | Risk/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 |