When Lindsay Fox gave birth to her first baby last week, the Taylorville resident didn't think twice about whether her son should receive a shot of Vitamin K.
The injection in a baby's thigh, often given within an hour of birth, has been widely recommended by doctors since 1962. Doctors say Vitamin K shots have reduced rare but life-threatening cases of bleeding in the brain and intestines among babies, who are born with low Vitamin K levels.
"I knew it was to help with the clotting," Fox, 30, said of the Vitamin K shot that her son, Dean, received shortly after his birth Wednesday at HSHS St. John's Hospital. "Why wouldn't you want to help them in any way possible?"
But doctors and hospitals officials in Springfield, as well as elsewhere in Illinois and the rest of the country, have noticed a trend: A growing number of parents refusing Vitamin K shots for their newborns.
Doctors fear the trend, which they connect with the anti-vaccine movement and mistrust of conventional medicine in general, will lead to an increase in the estimated 80 cases of Vitamin K deficiency bleeding among infants each year in the United States.
"While it's rare, it's devastating," Dr. Douglas Carlson, medical director of Springfield's HSHS St. John's Children's Hospital, said of the condition.
St. John's "strongly recommends" Vitamin K shots at birth as an almost foolproof method for preventing such bleeding until babies are 4 months to 6 months of age, when natural Vitamin K levels rise.
But Carlson, who also is chairman of pediatrics at Springfield's Southern Illinois University School of Medicine, said doctors at St. John's and Memorial Medical Center have seen a slight increase in parents declining Vitamin K shots for their babies in recent years.
'A national crisis'
Pediatrician Dr. Jill Glick, who specializes in child-abuse detection and is medical director of child advocacy at the University of Chicago's Comer Children's Hospital, said the increase in parental refusal of Vitamin K is "a national crisis" rooted in "a societal distrust of the medical community and science."
Even though a Vitamin K shot isn't a vaccine, it has been lumped together with vaccines as treatments that some parents consider unnecessary, according to Dr. Steven Abrams, a neonatologist at the University of Texas and chairman of the American Academy of Pediatrics' committee on nutrition.
Theories that childhood vaccines cause autism have been debunked. But they persist on the internet and in comments from celebrities. Decisions by parents to forgo vaccines for their children have been linked to outbreaks of measles in Minnesota, California and some other parts of the country.
According to some internet sites, Vitamin K shots increase a child's risk of developing childhood leukemia, but that association is unproven, according to the U.S. Centers for Disease Control and Prevention.
Some opponents of Vitamin K shots who are worried about components of the shot promote the use of oral Vitamin K for babies.
But oral Vitamin K isn't widely available in the United States, and several doses over a one-month period are needed, according to Abrams.
Moreover, oral Vitamin K hasn't been proven to be as effective as a Vitamin K shot, so Glick said it's a "suboptimal" choice.
Refusing a Vitamin K shot for a newborn, Glick said, is "really dumb and life-threatening. ... Everything in the Vitamin K shot is safe and effective. It's so benign but yet so valuable to children."
A multi-state study published by the American Academy of Pediatrics in July indicated parents of 0.6 percent of newborns are declining the shots, with refusal rates in some parts of the country approaching 2 percent.
As recently as five to 10 years ago, parental refusal of Vitamin K shots was unheard of, medical experts say.
"This is very much something that is hitting the horizon right now," Glick said.
Though the Illinois Department of Public Health doesn't keep track of Vitamin K refusals, a refusal rate of 0.6 percent would mean 12 newborns at St. John's, 930 babies in Illinois and 24,000 nationwide aren't getting the shot each year.
Babies who go without the shot soon after birth are 81 times more likely to develop serious bleeding, and one out of every five babies with Vitamin K deficiency bleeding dies, the CDC says.
Babies who survive the condition may have brain damage and lifelong disabilities.
Illinois institutes, then rescinds reporting policy
Doctors' concerns about parental refusals of Vitamin K prompted the Illinois Department of Children and Family Services to institute a policy in 2015 requiring doctors and other health-care providers to report such refusals to DCFS as potential cases of medical neglect.
The policy was rescinded by DCFS acting director Beverly Walker in August after parents upset about the policy complained to the agency and at public events, Walker said.
The parents "believed they should not be forced to give their kids Vitamin K," she said. "There was concern that they were being reported to DCFS."
Walker told The State Journal-Register she wasn't part of DCFS in 2015 but that she investigated the issue earlier this year and took action. She said complaints from parents resulted in her evaluating the issue, but her decision wasn't made to quell the complaints.
Walker said she supports the use of Vitamin K shots for infants. But the previous policy "oversteps the boundaries that we, by law and by our expertise, should be involving ourselves in," she said. "We're not medical professionals, so we should not be defining what is medically necessary or not. And in addition to that, we shouldn't be telling doctors ... what medical neglect is."
James Holderman, 43, who said he lives with his family in one of Chicago's western suburbs, said he was "instrumental" in the DCFS policy being rescinded after health-care providers at a Chicago-area hospital filed a complaint about him and his wife, Courtney, 40, in May following the birth of their second child.
As with their first child -- born in 2014 at the same hospital when the DCFS policy wasn't in effect -- Holderman and his wife declined a Vitamin K shot for their second child. They also declined the application of antibiotic ointment in the eyes for both children; the ointment is applied to prevent eye infections.
The DCFS investigation that resulted this year turned out to be unfounded but was emotionally traumatic, Holderman said.
He said his complaints to DCFS were part of an effort by thousands of parents to change the policy, which also made refusal of the eye ointment a case of medical neglect that should be reported.
An online petition led to discussions among parents with several members of the Illinois General Assembly, Holderman said.
A phone message left with the office of state Sen. John Curran, R-Downers Grove, in whose district Holderman lives, wasn't returned last week.
Neil Skene, special assistant to the DCFS director, wouldn't comment on Holderman's statements.
A "position statement" issued by DCFS said the agency conducted 138 investigations for medical neglect involving Vitamin K from Jan. 1, 2014, to June 20, 2018, and seven of those investigations were "indicated" for medical neglect -- meaning DCFS officials believed medical neglect occurred. One investigation remains pending.
In all of the seven "indicated" cases, Vitamin K refusal wasn't the only concern, Walker said. "There were other abuse and neglect issues attached to the family," she said.
Walker said she didn't know whether the investigations resulted in children being removed from their homes.
'Harsh tactics of coercion'
Holderman said he and his wife declined Vitamin K and the eye ointment because they consider neither to be necessary medical treatments soon after birth.
"There is no one who cares more about the health and well-being of our children than my wife and me," Holderman said. "The medical opinion that all babies are deficient in Vitamin K at birth and are therefore at serious risk of life-threatening medical complications is an overly simplified, blanket assumption that is not evident in science, history or certain religious beliefs and practices.
"Further, the administration of an intramuscular Vitamin K shot is itself not without risk," he said, adding, "I believe that the harsh tactics of coercion or forced administration used by some hospitals only serve to further undermine the credibility of a portion of the medical profession that is plagued by significant, self-serving conflicts of interest."
Glick said Holderman is wrong when he says medical opinion supporting Vitamin K shots is not pervasive.
"It is so well-entrenched in international medicine," she said.
But Glick and Abrams said better education of pregnant women about the benefits of Vitamin K for their newborn babies, rather than a state rule requiring Illinois doctors to report parents for potential medical neglect, is the best way to reduce resistance to the shots.
The CDC says state laws and policies vary nationwide when it comes to Vitamin K. Unlike New York and Oregon, Illinois doesn't require that newborns receive Vitamin K.
Glick said Comer Children's Hospital began to require Vitamin K shots at birth a few months ago -- and not allowing parents to say "no" -- because of the importance of the shot and the current climate of parents questioning an obviously beneficial treatment.
The decision at the Chicago hospital came with a renewed emphasis on patient education as part of prenatal visits with obstetricians practicing at the hospital, she said.
Glick said she would like more hospitals to be decisive when it comes to Vitamin K, but she said she understands why many hospitals continue to let parents choose.
"People don't want conflict," she said.
An increase in parents declining Vitamin K shots for newborns this spring and summer prompted the 12 hospitals in the Downers Grove-based Advocate chain -- including Advocate BroMenn Medical Center in Normal -- to develop uniform documents for patients to sign when they decline. Advocate hospitals are the site of about 21,000 deliveries each year.
Advocate also began keeping track of Vitamin K refusals, according to Dr. Frank Belmonte, chief medical officer of the Advocate children's hospitals in Park Ridge and Oak Lawn.
Advocate doctors are working to educate parents about the dangers associated with declining Vitamin K shots for their babies, Belmonte said.
"There's a lot of false information out there," he said. "It's hard. The internet has made it very difficult for people to figure out what is real, what is scientific and what is not."
At St. John's, Carlson said, the children's hospital plans to educate doctors practicing there on ways of better addressing concerns of pregnant patients so denials of Vitamin K shots are kept "very low," Carlson said.