What I Actually Think About Newborn Shots, Ointment, and Screenings

One thing I wish more expecting parents heard before delivery is that the first hours after birth can feel surprisingly busy.

You are meeting this tiny person you have waited months to hold. You are trying to absorb their little face, figure out feeding, recover from delivery, and maybe sleep for twenty minutes.

When you’re rolling into the hospital or in a fog postpartum someone asks whether you consent to a vitamin K shot, eye ointment, the Hep B vaccine. Or they may have you sign a consent form for these three things. 

In the medical world, we have a shorthand for this: “eyes and thighs.” It refers to the erythromycin ointment placed in your baby's eyes and the two injections given in the thighs, the vitamin K shot and the Hep B vaccine. You might hear it from a nurse, see it on a consent form, or have someone ask you about it while you are still very much in the fog of those first hours after delivery. Knowing the nickname is one thing. Knowing what each one actually does is another.

Later, there is a heel prick, a hearing test, and a little sensor wrapped around your baby’s hand and foot.

Even when you know these things are coming, it can feel like a lot.

I have been thinking about this more lately because I keep seeing routine newborn care framed online as a checklist of things to refuse in order to protect your baby.

Parents absolutely deserve to ask questions. You should understand what is being offered and why. But you also deserve the full context before you are standing in a hospital room, exhausted, trying to make decisions for a brand-new baby.

These are not all doing the same thing.

A helpful place to begin is recognizing that the things offered in the hospital fall into a few different categories.

Some are preventive treatments. They are offered to reduce the risk of a serious problem before it happens.

Others are screenings. They help identify conditions that may not be obvious simply by looking at a newborn, but where early care can make an enormous difference.

The vitamin K shot: Preventing unexpected bleeding

Vitamin K helps our blood clot. Babies are naturally born with very small amounts of it stored in their bodies, which means they are more vulnerable to a rare but potentially dangerous condition called vitamin K deficiency bleeding. This bleeding can happen internally. In some cases, it happens in the brain. And it may occur before parents see an obvious warning sign.

The vitamin K shot is a one-time injection given in the thigh shortly after birth. It is not a vaccine. It gives babies protection during the first months of life, when their vitamin K levels are naturally low.

Most babies who do not receive the shot will never experience a major bleed. The difficult part is that we cannot reliably predict which baby will. The CDC has found that newborns who skip the vitamin K shot are 81 times more likely to develop severe bleeding than newborns who receive it. Vitamin K deficiency bleeding can happen in otherwise healthy babies up to 6 months of age. I have seen this twice in my career–I understand it doesn’t sound like a lot–BUT I am ONE doctor and the consequences were devastating. 

One thing worth noting: vitamin K refusal has increasingly been pulled into the same online conversations as vaccine refusal. The stakes of skipping it are real, the window to prevent harm is short, and the outcomes when it goes wrong can be permanent. That is a very different risk conversation than the ones people are used to having about routine vaccines. Remember to listen to this full episode with Dr. Jessica Knurick here about the importance of neonatal Vitamin K injections. 

Eye ointment: Protecting a newborn’s vision

The antibiotic ointment placed in a baby’s eyes after delivery is usually erythromycin. It is given to help prevent a serious newborn eye infection caused by gonorrhea, which can pass to a baby during delivery. When this infection happens, it can damage a baby’s vision quickly.

This does not mean anyone is assuming something about you or your prenatal care. It is another safety net. The ointment is offered routinely because missed infections and gaps in care can happen, and the potential consequence for a newborn can be significant. The U.S. Preventive Services Task Force gives newborn eye ointment its strongest recommendation, a Grade A, and for good reason. If a pregnant parent has gonorrhea and a baby does not receive preventive ointment, the chance of transmission during delivery is estimated to be 30% to 50%. The infection can cause eye damage and blindness very quickly, sometimes within the first 24 hours after birth.

The Hep B vaccine: Why the conversation has become louder

The Hep B vaccine is probably the newborn intervention receiving the most attention online right now. One common argument is that Hepatitis B is sexually transmitted, so vaccinating a newborn makes no sense. But Hepatitis B is also spread through blood and body fluids. Babies can be exposed during delivery. Children can also be exposed later through close household contact with someone who may not realize they carry the virus.

The reason pediatricians take newborn exposure so seriously is that age matters. When a baby is infected at birth, the infection is far more likely to become chronic, which can lead to liver damage, cirrhosis, or liver cancer years later.

There has also been a recent change in federal guidance. In December 2025, the CDC moved to shared decision-making for babies born to parents who test negative for Hepatitis B. Babies born to parents who test positive or whose status is unknown should still receive the vaccine within 12 hours of birth. The American Academy of Pediatrics continues to recommend the routine birth dose for all medically stable babies within the first 24 hours of life.

I know that difference can feel confusing.

My feelings on Hep B at birth, that birth dose is still a safety net I am glad we have. Universal recommendations are designed for real life, not a perfect system. Test results can be delayed. Prenatal screening can be missed. A parent may not know they have Hepatitis B. And children can be exposed through other routes after birth.

This is a fair conversation to have with your pediatrician. Asking questions is not a problem, but the answer deserves more nuance than “babies do not need protection from a sexually transmitted infection.” The AAP notes that routine infant vaccination has reduced pediatric Hepatitis B infections by 99% since 1991.

If you want to think through the full childhood vaccine picture before these decisions come up, my free PedsDocTalk Vaccine Guide walks through each one with the context behind it.

The heel stick: Looking for conditions before symptoms appear

Between 24 and 48 hours after birth, a provider will usually warm your baby's foot, make a small pinprick on the heel, and collect a few drops of blood onto circles on a special card. Once those spots dry, the card goes to a laboratory. This is the newborn blood spot screen.

Your baby may cry briefly, but they can often stay swaddled or be comforted during the process.

This screen looks for a range of rare but serious conditions, including PKU, sickle cell disease, and certain metabolic, hormonal, and genetic conditions. Many of these conditions are not obvious simply by looking at a newborn. Finding them early can allow treatment to begin before a baby becomes sick.

Every state has a newborn screening program, although the specific conditions included can vary. You can visit the HRSA Newborn Screening In Your State and select your state to see exactly what is included in your local screening panel. 

A screening result is not a diagnosis. If something comes back outside the expected range, your baby may need additional testing.

One practical note: Results are usually ready within five to seven days and are generally sent to your baby’s healthcare provider, not directly to you. Ask whether the results are back at your baby’s first or second visit. Do not assume that no phone call automatically means the results have been reviewed.

The hearing screen: A quick check that matters for development

This one is usually simple and painless, and it can often be done while your baby is calm, swaddled, or sleeping. Depending on the test, a provider may place small sensors on your baby's head or use a tiny earpiece to check how your baby's ears and brain respond to soft sounds.

If your baby does not pass the first hearing screen, take a breath. It does not automatically mean your baby has permanent hearing loss. Fluid in the ears, crying, or movement can affect the result. The next step is follow-up testing with an audiologist. Identifying hearing differences early allows families to access support during an important window for communication and language development. The CDC recommends screening all babies for hearing loss by 1 month of age, completing a full hearing test before 3 months for any baby who does not pass, and beginning support before 6 months if hearing loss is confirmed.

The pulse-ox screen: A small sensor with an important job

You may remember someone placing a little wrap or sticker around your baby’s hand and foot. That is the pulse-ox screen. It measures the oxygen level in your baby’s blood and can help identify certain serious heart conditions that may not be obvious before a newborn goes home.

The test is usually completed after a baby is at least 24 hours old. A provider places a small wrap around the right hand or wrist and one foot. One side has a light and the other has a sensor. It is painless, and the result comes quickly.

A baby who does not pass may simply need the screen repeated. Sometimes additional testing is needed to check how the heart and lungs are working.

 The pulse-ox screen cannot detect every heart condition, but it adds another layer of protection alongside the newborn physical exam. CDC data show that mandated pulse-ox screening has reduced early infant deaths from critical congenital heart defects by 33%, preventing an estimated 120 early infant deaths each year.

A birth plan is personal, not a template

I do not think parents should agree to something simply because it is offered. You deserve to understand what is being recommended, what it is meant to prevent, and whether there are any considerations specific to your baby.

But I also do not think parents should refuse routine newborn care simply because someone online shared the choices they made for their own baby. Birth plans are personal. Another parent may be making decisions based on their own labs, medical history, family circumstances, conversations with their healthcare team, and personal values. We rarely know the full context behind a social media post, even when it is shared very confidently.

Here is where I land, as a pediatrician and as a parent who went through this herself: I chose all three for my kids. Vitamin K, eye ointment, and the Hep B vaccine. All of them. And I feel really good about that. But I also want to be honest about the nuance. I can understand a parent in a monogamous relationship, with a negative Hep B test and no other risk factors, choosing to wait on the birth dose of Hepatitis B until going to their pediatrician’s office. I can understand someone skipping the eye ointment when gonorrhea exposure is genuinely not a concern. Those conversations are worth having with your provider, and the answer may look different depending on your situation. What I cannot get behind is skipping the vitamin K shot. The potential outcomes are too serious, the bleeding can be silent, and we cannot predict which babies are at risk. That one is not a risk I was willing to take, and it is not one I recommend.

Someone else’s decision may prompt you to ask more questions, and that can be helpful, but it should not become the reason you make the same decision for your baby.

Ideally, ask some of these questions before delivery, when you have a little more time to process the answers:

There is a big difference between making an informed decision and making one based on a viral post that leaves out the reason a recommendation exists in the first place.

The first days with a newborn already come with enough uncertainty. Having these conversations ahead of time can help you feel more prepared before the questions start coming at you in the hospital room.

And if you know someone preparing to welcome a baby, send this their way. It is much easier to think through these decisions before you are making them on very little sleep with a tiny new person in your arms.

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