Parents Increasingly Refuse Routine Preventive Care for Newborns Beyond Vaccines

Within hours of birth, most American babies receive three routine interventions: an intramuscular injection of vitamin K to prevent bleeding disorders, erythromycin antibiotic ointment applied to the eyes to prevent bacterial infection, and a first dose of hepatitis B vaccine. These procedures have been standard in U.S. hospitals for decades. Now, a growing number of parents are saying no—not just to vaccines, but to the full suite of preventive newborn care.

A study published in the Journal of the American Medical Association in December 2025, analyzing more than 5 million births across 403 hospitals in all 50 states, found that vitamin K refusal rose 77% over eight years—from 2.92% in 2017 to 5.18% in 2024 [1]. That translates to roughly 198,000 newborns who did not receive the shot during the study period [2]. And vitamin K refusal appears to be a gateway: among families who declined the injection, 93% also refused the hepatitis B birth dose, and 68% declined erythromycin eye ointment. Two-thirds refused all three [3].

The consequences are not theoretical. In Idaho, pediatricians reported eight infant deaths from vitamin K deficiency bleeding over a 13-month period [4]. At Children's Hospital of Philadelphia, clinicians documented increases in both refusals and bleeding events [1]. The question facing pediatricians, hospitals, and policymakers is no longer whether this trend exists, but how to respond before it produces a broader public health crisis.

What's Being Refused—and How Fast

Vitamin K is the intervention with the most robust tracking data. Newborns are born with low levels of the vitamin, which is essential for blood clotting. Without supplementation, approximately 1 in 60 babies historically suffered vitamin K deficiency bleeding (VKDB), a condition that can cause gastrointestinal hemorrhage, intracranial bleeding, and death [4]. The American Academy of Pediatrics has recommended universal intramuscular vitamin K since 1961.

The JAMA study, led by Dr. Kristan Scott at Children's Hospital of Philadelphia and funded by the NIH, used Epic Systems' Cosmos database to track administration rates [1]. The overall non-receipt rate across the study period was 3.92%. The increase accelerated around 2019-2020, coinciding with—but not fully explained by—the COVID-19 pandemic [2].

Source: JAMA / Children's Hospital of Philadelphia

Data as of Dec 8, 2025CSV

Erythromycin eye ointment refusal is harder to quantify nationally because tracking is less systematic, but hospital-level data and clinician reports indicate parallel increases [3]. Newborn metabolic screening—the "heel stick" blood test for conditions like phenylketonuria (PKU) and congenital hypothyroidism—has a different regulatory landscape. All 50 states mandate it by law, though most allow religious exemptions, and a handful permit refusal for any reason [5]. Refusal rates for metabolic screening remain low compared to vitamin K and eye ointment, partly because of this legal framework.

Hepatitis B vaccine refusal at birth has received more public attention given the broader vaccine debate. But the pattern of bundled refusal—parents declining everything offered in the first hours of life—suggests the phenomenon is broader than anti-vaccine sentiment alone [3].

Who Is Refusing, and Why

The demographic profile of parents who refuse newborn interventions challenges simple assumptions. Research consistently finds that refusers are disproportionately white, over 30, college-educated, and breastfeeding [6]. One study found that 78% of vitamin K refusers were white, 57% were over age 30, and 65% were college graduates [6]. The JAMA data confirmed this: non-Hispanic white newborns had the highest non-receipt rate at 4.3%, compared to 3.4% for non-Hispanic Black newborns and 3.3% for Hispanic newborns [2].

Birth setting is a powerful predictor. Refusal rates ranged from 0% to 3.2% in hospitals, up to 14.5% in home births, and as high as 31% in freestanding birthing centers [6]. Women who had midwife-assisted deliveries were eight times more likely to refuse vitamin K than those with physician-attended births [6].

The reasons parents give are distinct from standard vaccine hesitancy, though there is overlap. In surveys, the most commonly cited reasons were a belief that the injection was unnecessary (53%) and a desire for a "natural" birthing process (36%) [3]. When probed further, parents mentioned concerns about synthetic or toxic ingredients (37%), the dose being excessive for an infant (28%), and potential side effects (24%). The internet was the primary information source for 70% of refusers [6].

"I hear from families that it's hard to make decisions right now because they're hearing conflicting information," Dr. Kelly Wade, a neonatologist, told CBS News [4]. Social media plays a significant role, spreading claims that vitamin K injections contain harmful preservatives or that oral drops are an equivalent substitute—a claim pediatricians dispute, noting that oral vitamin K is less reliably absorbed and requires multiple doses over weeks [1].

Some parents frame their refusal in terms of bodily autonomy and informed consent rather than specific safety concerns. This philosophical position—that parents should have the right to accept or reject any medical intervention for their child—sits at the intersection of the natural birth movement, libertarian politics, and broader institutional distrust that intensified during the pandemic [6].

The Medical Stakes

The health consequences of vitamin K refusal are the most clearly documented. Newborns who do not receive intramuscular vitamin K are 81 times more likely to develop VKDB [1]. Late-onset VKDB, which can occur up to six months after birth, carries a 20-50% mortality rate [1]. Among reported cases, approximately 63% present with intracranial hemorrhage; about 14% of affected infants die; and roughly 40% of survivors develop long-term neurological disability [7].

In 2013, four cases of late-onset VKDB in the Nashville area—all in infants whose parents had declined vitamin K—triggered a CDC investigation [8]. More recently, Idaho has emerged as a focal point: at a February 2026 meeting of the Idaho chapter of the American Academy of Pediatrics, physicians reported eight VKDB deaths in the state over the prior 13 months [4]. One pediatrician described a toddler who suffered stroke-like events as a newborn after vitamin K refusal, resulting in severe developmental delays and ongoing seizures [4].

"When you look at a child who's innocent and vulnerable—a simple intervention done since 1961 is refused—knowing that baby's going out into the world is super worrisome," said Dr. Tom Patterson [4].

For erythromycin eye ointment, the risk calculus is more nuanced. The ointment was introduced to prevent ophthalmia neonatorum—eye infections caused by Neisseria gonorrhoeae contracted during vaginal delivery, which can cause blindness if untreated. For metabolic screening, the stakes are different but equally serious: undetected PKU can cause irreversible intellectual disability, while undetected congenital hypothyroidism can impair growth and cognitive development. These conditions are treatable if caught early, but the window for intervention is narrow [5].

A Legitimate Debate: Are All Interventions Equal?

Not all newborn interventions rest on equally strong evidence, and acknowledging this is essential to understanding why some parents push back.

Erythromycin eye ointment is the clearest case of an intervention that many medical authorities now consider outdated. The Canadian Paediatric Society stopped recommending universal erythromycin prophylaxis in 2015 [9]. The United Kingdom, Denmark, Norway, and Sweden have also dropped it from routine protocols [9]. Their reasoning: gonorrhea rates have fallen dramatically since universal prenatal screening became standard; erythromycin is ineffective against chlamydia, the more common pathogen today; and many bacterial strains are now resistant to the antibiotic [9].

The AAP has acknowledged this shift, proposing an alternative strategy based on prenatal STI screening, testing unscreened mothers at delivery, and counseling parents to seek immediate care if a newborn develops eye symptoms [9]. Yet many U.S. states still mandate the ointment by law, creating a situation where parents in those jurisdictions cannot legally decline an intervention that peer countries have abandoned on evidence grounds.

This disconnect fuels broader skepticism. Parents who learn that erythromycin is no longer recommended in Canada may generalize that skepticism to vitamin K—an intervention with far stronger evidence behind it. "The problem," as one pediatric researcher noted, "is that when one part of the bundle looks questionable, parents start questioning the whole bundle" [3].

Source: PMC / Refusal of Intramuscular Vitamin K by Parents of Newborns: A Review

Data as of Feb 1, 2020CSV

Vitamin K prophylaxis, by contrast, has robust international support. Every major pediatric society worldwide recommends it. The debate is over route of administration, not whether to give it at all. The U.S., Canada, Australia, and most European countries prefer intramuscular injection as the most reliable method [10]. Some countries offer oral alternatives: Denmark uses a protocol of 2 mg at birth followed by 1 mg weekly for 12 weeks, with efficacy approaching that of injection for low-risk infants [10]. The Netherlands exclusively uses oral prophylaxis [10]. Countries that switched from injection to oral vitamin K in the 1990s—notably parts of the UK and Australia—saw increases in late-onset VKDB, leading most to revert to injection as the preferred route [10].

Hospitals, Waivers, and the Law

The legal landscape around newborn care refusal is fragmented and evolving.

For metabolic screening, the framework is relatively clear: all 50 states mandate it by law, most allowing only religious exemptions [5]. For vitamin K and erythromycin, requirements vary widely. Some states mandate erythromycin but not vitamin K. Some require documentation of informed refusal. Few have explicit enforcement mechanisms.

When parents refuse vitamin K, hospitals typically follow a standard escalation: education, counseling on risks, and if the refusal persists, documentation through an informed refusal waiver [11]. But the effectiveness of these waivers is questionable. In one documented case, a mother who had signed a refusal form later said she thought vitamin K was "just a vitamin" and wished she had been better informed [11].

Some institutions have gone further. In Illinois, several families were subjected to Department of Children and Family Services investigations after refusing vitamin K, with some investigations lasting two months—even though the parents had signed informed consent waivers [12]. The families sued, and Illinois subsequently changed its policy; hospitals are no longer required to report vitamin K refusal to DCFS [12].

The legal framework rests on a tension articulated in a 2023 analysis in the Journal of Pediatrics: the Child Abuse Prevention and Treatment Act established that withholding medically indicated treatment from a newborn can constitute neglect, but whether vitamin K refusal meets that threshold remains legally untested in most jurisdictions [11]. The analysis concluded that "the autonomy over the choice to proceed with the intervention ultimately lies with child services of the state, notified via obligated reporting from hospital ethics committees" [11].

New York took a different approach. In 2020, the state Department of Health issued guidance requiring hospitals to document vitamin K refusal and attempt re-education, but stopping short of mandatory administration or CPS referral [13].

International Context

The U.S. is not an outlier in recommending newborn preventive care, but it is unusual in the degree to which these interventions are contested by parents.

In Canada, the Canadian Paediatric Society recommends intramuscular vitamin K for all newborns, with oral vitamin K reserved only for cases where parents decline the injection [10]. Refusal rates in Canada and Europe remain well below U.S. levels, though precise international comparisons are difficult due to differing surveillance systems.

Source: World Bank

Data as of Dec 31, 2023CSV

Neonatal mortality rates offer indirect context. The U.S. had a neonatal mortality rate of 3.4 per 1,000 live births in 2023, higher than all the Nordic countries (Norway: 1.3, Sweden: 1.5, Denmark: 1.8) and Australia (2.3), though comparable to Canada (3.4) and the UK (2.7) [14]. These differences reflect many factors beyond newborn intervention rates—including maternal health, poverty, and healthcare access—but they underscore that the U.S. already trails peer countries on infant survival metrics.

The Dutch experience with oral-only vitamin K prophylaxis is instructive. The Netherlands has maintained an oral protocol without reported increases in VKDB, but its system relies on a well-coordinated postnatal home-visiting program that ensures multiple oral doses are administered on schedule [10]. Transplanting that approach to the U.S., with its fragmented postnatal care system, would be far more difficult.

What Comes Next

If current trends continue—vitamin K refusal doubling roughly every eight years—the rate could reach 10% of U.S. births by the early 2030s. At that level, with approximately 3.6 million births annually, more than 360,000 newborns per year would go unprotected. Given an 81-fold increase in VKDB risk, clinicians project a measurable rise in infant hemorrhagic events, particularly in states with high refusal rates and limited follow-up care [1].

The policy responses under discussion range from incremental to coercive. Some pediatricians advocate for better prenatal education, noting that parents who receive information about vitamin K before delivery are more likely to accept it [6]. Others argue for making vitamin K as legally mandatory as metabolic screening, removing the option to refuse. A middle path—offering oral vitamin K as a compromise for injection-averse parents, as Canada does—has gained support among some clinicians, though professional guidelines continue to recommend injection as the gold standard [10].

The broader concern is that newborn care refusal represents the next front in a widening conflict over medical authority. Vaccine hesitancy was the first wave. Refusal of non-vaccine interventions—vitamin K, eye ointment, screening tests—is the second. Each refusal carries its own risk profile and evidence base, but they are increasingly linked in parental decision-making and in the online ecosystems that inform those decisions.

"Nature will allow 1 in 5 human infants to die in the first year of life," said Dr. David Hill, a pediatrician, framing the stakes in evolutionary terms [4]. The interventions under debate were designed to close that gap. Whether parents retain the right to reopen it—and under what circumstances—is a question the medical and legal systems have yet to fully answer.