Pets with brachycephaly and how to care for them
Caring for a brachycephalic (flat-faced) pet is a big responsibility. With increased risks of many health issues, shorter lifespans and even a lower quality of life, they may need regular vet visits, daily medications and even surgical treatments.
On this page, you’ll learn about brachycephaly and the issues it causes, common brachycephalic pet breeds, and how best to care for them.
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What is brachycephaly?
Brachycephaly is the scientific name for ‘flat-faced’ pets, including dogs, cats, rabbits and other animals. While many pet owners see this as a desirable trait, it’s actually an extreme conformation that can cause the animal unimaginable suffering.
Brachycephaly refers to the shortened shape of the animal's skull compared to other animals of the same species. It results in a flattened face and shortened muzzle, and in cats and dogs is often accompanied by protruding eyes and facial skin folds. An animal who is brachycephalic means one who’s been intentionally bred for this small skull, and is likely to suffer as a result. It’s primarily caused by selective breeding.
Animals with brachycephaly (flat-faces) are at much greater risk of developing serious and painful health problems compared to other animals. Their exaggerated physical features inhibit normal functions, such as breathing, temperature regulation, blinking and eating.
Unfortunately, due to the popularity of affected breeds (heightened by their presence on social media), many of these health problems have become so normalised that some people don’t even recognise them as a problem. Many prospective pet owners seek out these traits, seeing dogs and cats with squished faces as “cute” and not as the damaging deformities they actually are. Some brachycephalic pets need lifelong medical attention and additional care, which can be expensive and deeply distressing for both owner and animal.
It’s sad to see dogs struggling to live normal, happy lives because they've been bred to look a certain way. Wouldn't it be great if all dogs were bred with the best chance of living healthily instead?
What issues do bracycephalic features cause?
Brachycephalic Obstructive Airway Syndrome (BOAS)
Brachycephalic Obstructive Airway Syndrome (BOAS) is the clinical term to describe breathing difficulties that occur due to a shortened muzzle and flattened face. Animals with brachycephaly have the normal amount of soft tissue in the mouth and throat, but in a much smaller space due to their shortened skulls. This restricts movement of air when breathing. Specific physical features include narrow nostrils, a long soft palate and a narrow windpipe.
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- Noisy breathing (wheezing, rasping, sneezing, snorting)
- Sticking their tongue out frequently
- Disrupted sleep
- Sleeping or lying with their head raised or sleeping sitting upright
- Sleeping with toys in their mouth to prop it open
- Sleeping or resting with their tongue out of their mouth
- Increased breathing effort
- Inability or unwillingness to exercise (which may contribute to being overweight, which further exacerbates other BOAS symptoms)
- Sneezing frequently
- ‘Reverse-sneezing’ – sporadic, rapid inhalations
- Open-mouth breathing in cats
- Open-mouth breathing in dogs, when not exercising/panting
- Difficulty eating (gagging, retching, coughing, spitting food etc)
- Vomiting/regurgitation
- Collapse
If you think your pet is suffering from BOAS, contact your vet.
Dogs with brachycephaly are less able to regulate their temperature, so they’re up to 16 times more likely to suffer from heat-related illnesses. Dogs typically cool down by panting, but dogs with brachycephaly are unable to pant effectively, due to the shortened nose and malformed soft tissue in the nose and throat. Find out how to help dogs on hot walks or dogs with heatstroke here.
Brachycephalic cats are also at risk. Many of their symptoms are the same as dogs, although they can be harder to spot.
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A vet will diagnose BOAS after examining the animal’s airway, using exercise intolerance tests and taking images using X-ray, endoscope, computed tomography (CT) and/or magnetic resonance imaging (MRI) scans.
Brachycephalic obstructive airway syndrome treatment depends on the severity of the condition. In the mildest cases, weight management and routine changes (such as not walking in warm weather) may be enough to minimise the animal’s suffering.
However, in many cases, surgical treatment is required to attempt to provide a reasonable quality of life for pets with BOAS. Surgery might include widening of the nostrils, reduction of the soft palate, removal of excessive tissue in the throat and removal of the tonsils. Surgery is not curative – animals with brachycephaly will still experience breathing difficulties throughout their lives.
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BOAS affects all parts of an animal's life and causes considerable distress, fear and frustration. An inability to breathe also affects their ability to play, exercise, communicate with other animals, eat and drink and sleep. Sleep deprivation can cause other health and behavioural problems such as aggression and reduced immunity. BOAS is a progressive disorder that worsens with age and dramatically reduces lifespan.
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Dental problems
While dental issues can affect all animals, cats and dogs with brachycephaly are more likely to have dental problems compared to those with normal length skulls (research in brachycephalic dogs found a 25% increased risk). This is due to overcrowding in the mouth. They have the same number of teeth but a much smaller jaw, so the teeth overlap or do not erupt, causing periodontal disease (infection and inflammation of the gums and teeth).
The association between skull shape and dental disease in rabbits is conflicting. Dental disease in rabbits is sometimes associated with lop-ears and many lop-eared rabbits are classified as brachycephalic.
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Symptoms of dental problems in all species include:
- Pawing at the mouth
- Head shaking
- Jaw chattering
- Dropping food when eating
- Difficulty eating (they may chew on one side only)
- Difficulty swallowing
- Drooling
- Bad breath
- Red/bleeding gums
- Reduced appetite
- Weight loss
- Plaque and tartar on the teeth
- Wobbly teeth
- Facial swelling
Additional symptoms seen only in rabbits include:
- Overgrown teeth
- Watery eyes
- Swelling around the eyes
- Diarrhoea or soft faeces
- Dirty bottom
If you think your pet is suffering from BOAS, contact your vet.
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A vet will diagnose dental disease after examining the animal’s mouth. X-rays may also be required. Treatment may include pain relief, antibiotics and a dental procedure where the teeth are cleaned and any loose, overgrown or infected teeth are removed.
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Dental disease has a significant impact on welfare, largely because the problem often goes unnoticed. Dental disease causes significant pain, affecting normal behaviour and, in rabbits, can be fatal. Animals may still eat despite the pain, because their survival instinct to eat is stronger than any behaviour changes caused by pain. Dental disease is also associated with poor health, and can lead to problems such as kidney, heart and liver disease.
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Eye conditions
While all animals are at risk of eye problems, the risk is increased for animals with brachycephaly. Research has found that dogs with brachycephaly are 11 times more likely to suffer from corneal ulcerations compared to non-brachycephalic dogs, and 15.3% of Persian cats were diagnosed with eye problems, making this the second most prevalent disorder after coat problems such as matting. Brachycephalic rabbits are over three times more likely to have tear duct abnormalities.
The term Brachycephalic Ocular Syndrome (BOS) is used to describe eye problems that have occurred due to an animal's skull shape. As the skull shape becomes flattened, the eye socket is shallow, causing the eyes to bulge forward. This means the eyelids don’t properly cover the eyes when the animal blinks, reducing protection and lubrication. Additionally, many of these animals have tear duct abnormalities, which can worsen eye problems.
Brachycephalic animals are at increased risk of ulceration, dry eyes, eyelash growth abnormalities, and physical trauma to the eye, as they’re more susceptible to injury. Left untreated, vision can be permanently impaired.
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Symptoms of eye conditions include:
- Rubbing their eyes
- Discharge
- Irritation
- Blinking/winking frequently
- Redness in the whites of the eyes
- Cloudy eyes
- Watery eyes and excessive tear production (often shown by brown stained fur in the corner of the eye)
If you think your pet is suffering from BOAS, contact your vet.
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A vet will diagnose any eye conditions following examination of both eyes. Depending on the condition, treatment may include pain relief, antibiotics for any infection, life-long medication for the eyes or surgery. Some eye conditions are an emergency – always contact your vet as soon as you have any concerns.
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Eye problems can cause consistent pain, discomfort and can lead to blindness. Surgical treatment can help, although multiple treatments and ongoing care at home is often required.
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Skin disease
Brachycephalic animals are more likely to suffer with skin disease such as ear problems, skin fold dermatitis, bacterial infection, inflammation of the paws and allergies.
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Symptoms of skin disease include:
- Itching, scratching, rubbing the body against objects or surfaces
- Hair loss
- Redness
- Excessive licking (this may cause a change in coat colour to brown/pink/orange)
- Odours from the skin
- Swelling of the affected area
- Dirty bottom (rabbits)
If you think your pet is suffering from BOAS, contact your vet.
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A vet will diagnose skin problems following examination of the affected areas. They may need to take samples and have these tested in a laboratory. Treatment is usually pain relief, life-long medication (oral and topical), shampoos and sometimes a special diet.
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Skin disease can have a significant impact on welfare due to the discomfort it causes throughout the animal’s life. In severe cases, it can affect their mental state, causing distress and altered behaviour. Treatment is often lifelong, requiring multiple trips to the vets and treatment at home, which may cause fear.
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Difficulty giving birth
Some brachycephalic animals, like dogs and occasionally cats, are unable to mate or give birth naturally due to the size of their pelvis; it may be too small to accommodate the larger head sizes of their offspring. This means that babies can’t pass through without medical or surgical treatment.
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Symptoms of a difficult birth include:
- Prolonged contractions without delivery
- Long gaps between delivery of each offspring in the litter
- Black or green discharge from the vulva
- Prolonged gestation
Difficulty giving birth is a veterinary emergency. If you think your pet is suffering from any of these signs, contact your vet immediately.
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Animals may have to undergo a caesarian section – which is painful and requires medication. Those who do are more likely to require caesarians with any future litters. Sadly, in one study, over 80% of some brachycephalic dog breeds were found to require a caesarian section. Without vet intervention, birthing difficulties can be fatal for the mother and the offspring.
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An inability to give birth causes severe pain and distress, and can lead to other complications, such as infection. For animals with brachycephaly, difficulty giving birth also worsens their pre-existing breathing problems. Pain and distress can last hours or even days if vet treatment is not sought, and mortality rates of both the mother and offspring are very high.
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Spinal and tail malformations
Some brachycephalic dog breeds are more likely to have spinal abnormalities. These can cause problems – such as an inability to walk, severe pain, and urine and faecal incontinence – which can be severe and will worsen with age. Up to 83% of some brachycephalic dog breeds have spinal defects, and dogs with a screw tail are more likely to have other deformities of the spine.
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Symptoms of spinal and tail malformations include:
- Pain from the spine and/or abdominal region
- Reluctance or inability to move
- Difficulty walking, standing and rising
- Dragging feet
- Vocalisation when picked up
- Lack of coordination
- Loss of bladder and/or bowel control
Sudden onset of spinal problems is a veterinary emergency. If you notice anything concerning, contact your vet immediately.
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A vet will diagnose spinal problems after examination. X-rays, CT scans and MRI scans may be required. Spinal and neurological problems are often very complex and challenging to treat, and may require life-long management. Medical treatment can include long-term pain relief and may require adaptations to your home and daily routine to accommodate your pet’s individual needs. Surgery may also be required to remove any problematic areas of the spine and/or tail vertebrae.
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Those affected can experience pain, loss of function and incontinence, which cause fear and frustration as the animal is unable to perform normal behaviours. The surgery required is a major operation, requiring intensive long-term treatment which affects daily life and routine. Some animals never recover and have to be euthanised to prevent further suffering.
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Impact of brachycephaly on behaviour
Physical inhibition
Many brachycephalic animals are unable to live a normal life and engage in important behaviours such as play, exercise, eating, grooming and sleep. This causes frustration and can lead to other behavioural and medical problems.
Pain
Chronic pain inhibits motivation and ability to engage in many normal activities, even if they are physically able to do so. These animals are not lazy, stubborn, disobedient or difficult to train; they are physically struggling to perform routine tasks.
Communication
Their exaggerated features, such as skin folds and lack of tail, may also limit their ability to communicate normally with other animals and humans, which can cause misinterpretation and escalate conflict.
If you have any concerns about your pet’s behaviour, always seek the advice of a veterinary professional or a clinical animal behaviourist. If you’re concerned about the health of your brachycephalic pet, please contact your vet.
(2024²)
¹Blue Cross ‘#EndTheTrend’ 2021
²RVC’s VetCompass study of pet rabbits 2024
³ EuroGroup’s ‘Extreme breeding in Europe’ report 2023
Common brachycephalic breeds
Find a list of breeds that commonly suffer from brachycephaly below:
Dogs
- Affenpinscher
- Boston terrier
- Boxer
- Brussels griffon
- Bullmastiff
- Cavalier King Charles spaniel
- Chihuahua
- Chow chow
- King Charles spaniel
- Lhasa apso
- Dogue de Bordeaux
- English bulldog
- French bulldog
- Japanese chin
- Mastiffs
- Pekingese
- Pug
- Shih-tzu
- Tibetan spaniel
- Yorkshire terrier
Cats
- Burmese
- British shorthair
- British longhair
- Exotic shorthair
- Himalayan
- Persian
- Scottish fold
Rabbits
- Angora varieties
- Blanc de hotot
- Czech
- Dwarf varieties
- Jersey wooly
- Lionhead
- Lop varieties
- Mini varieties
- Polish
- Smoke pearl
- Spanish giant valenciano
- Teddywidder
These are not exhaustive lists, and any animal with a shortened nose, even crossbreeds, can be brachycephalic.
Read more on genetic health issues in pets
