The following are the most critical factors that you need to be on alert for after puppies are born and essentially for the first several weeks of life.  Those weeks when they are most vulnerable.  

1. Hypoxia – breathing

2. Hypothermia – body heat

3. Hypoglycemia – blood sugar levels

4. Hydration

5. Infection

 

HYPOXIA – Breathing

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What to look for:

• Not breathing or labored breathing

• Pale gums and/or flat/grey tongue

• Low activity and mobility – just too quiet

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What to do:

1.  Stimulation through rubbing​​​

a. Vigorously rubbing back, body and sides

b. Head down at a 45 degree angle

2.  Acupuncture –inserting a small, fine gauge needle (typically a 25-gauge) into the nasal philtrum (the area between the nostrils), can stimulate breathing in a struggling puppy

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3.  Suctioning - using bulb

a. Bulb syringe nose and mouth

b. Squeeze bulb to expel air out BEFORE putting into puppy’s mouth – this creates the suction needed to pull fluids out

c.  Release bulb once deep inside of throat area to suction out fluids

d.  Repeat for each nostril.

4.  Suctioning using a Delee mucus trap

5.  Caffeine – a drop of coffee or 5 Hour Energy can help perk up a listless puppy

6.  Accordion stretch

a.  Always keep head pointed down at like a 45-degree angle

b.  Stretch the puppy to its fullest length as it takes in air. Count to 4

c.  Push the puppy’s head toward the hind end to expel fluid in lungs.

d.  Repeat the STRETCH – WAIT – PUSH sequence 14 to 16 times per minute.

e.  WAIT – STOPPING PUSHING if after 3 or 4 pushes no fluid is forth coming.

f.  IF the fluid is being expelled, continue on until no more fluid is seen coming out of the puppy,

7.  Oxygen

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Do not give up trying to get a puppy breathing just because you aren’t successful immediately.  If their heart is beating, you can work on a puppy for as much as 30 minutes.  Don’t give up too soon.  Also don’t be too gentle.  You can’t kill a dead puppy so if you’re going to lose them, being too rough isn’t going to hurt them.

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If things are hectic with other puppies, place the puppy in a container and tilt the container so that their head is below their butt.  Puppy’s head down the ‘slide’.  This position alone can help fluids drain and sometimes make them mad so that they cry and fuss.  This can help clear airways.

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NOTE: If their tongue is curled and pink, keep working.  Flat and grey – not likely to survive. 

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NOTE: Puppies are born in breech position – butt first - commonly.   In fact, 40% of the time.  Puppies may start breathing while their head is still in the sac during birth, inhaling fluid into their lungs as the mother licks and stimulates the part of their body which is already out. 

 

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HYPOTHERMIA – Are they warm enough?

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Attention to temperature control for newborn puppies is something that cannot be overstated. And the process begins right from the moment puppies are born.

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Puppies will vary in size, shape, hair length, etc., but in general all puppies are unable to regulate their body temperature from the time they are born until around 3 weeks of age.  And while the need for warmth seems obvious, it is critical to understand that this requirement goes beyond just them being physically comfortable. 

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Why don’t you feed a cold puppy?

When a newborn puppy’s body temperature falls below 93.2°F, it loses its ability to digest. Bottle-feeding under these circumstances means the milk would just sit in the stomach, potentially leading to bloating and the risk of false aspiration, which is dangerous.  Which is why you NEVER FEED A COLD PUPPY!!!

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A critical point to note is that the suckling reflex stops when their body temperature drops too low.  But even if a puppy would be willing to suck on its own or if you were planning on tube feeding, it is not safe if the puppy’s temperature is below 93.2°F.

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When a puppy is cold, their body prioritizes staying warm over digestion.  It takes energy to stay warm as well as to eat but a puppy will try to generate warmth.  And so left to their own devices a cold puppy will not eat on their own.  If forced to eat, they won’t be able to properly absorb nutrients and in fact this may lead to hypothermia and dehydration. 

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How do you know if your puppy is too cold?

You’ll need a thermometer.  Using a human baby thermometer rectally with small puppies can seem scary but with a little Vaseline on the tip, inserted just to the metal tip of the thermometer, you can quickly get an accurate temperature with minimal discomfort to even the smallest puppy. 

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While obviously less accurate, the visible signs of temperature stress in puppies can include excessive whining, lethargy, or reluctance to feed. On the other hand, a comfortable litter of puppies will be quiet, sleep peacefully, and have a good appetite.

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Normal Neonatal Temperatures

Week 1:         95 - 99 °F

Week 2 & 3:   97 - 100 °F 

Week 4:          99- 101 °F

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​​​How to keep them warm

While in a litter of puppies with a mother they may be able to sustain proper body temperatures through contact with their littermates and their mother in normal home conditions, that may not always be the case.  Orphan puppies will absolutely need outside help to stay warm.

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If the puppy is very young and very cold, immediately wrap the puppy in a hand towel or blanket, leaving only the face exposed. Do NOT take the puppy out of the towel to adjust or check on it—this lets critical heat escape.   Do this while you prepare other longer term means to warm them up.

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The whelping box or nest where newborn puppies are kept should be heated at around 84 to 89°F. And as puppies grow older and as their ability to regulate their body temperature gradually improves, you may likewise gradually decrease the environmental temperature.

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Obviously if you can maintain the heat of the room or space where the puppies are housed, that makes it easy.  Using supplemental heat sources tends to be common practice.  Such sources may include rice bags, warming discs, heating pads, radiant heaters and infrared or smart heat lamps. 

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NOTE: Keep in mind that puppies should always have the option to remove themselves from the heat if they wish.  Specifically, the housing for the puppies should provide spaces void of direct contact with the heat. 

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Incubators are a great thing to invest in if you plan on regularly fostering young puppies (and kittens).  They allow you to control the temperature of the environment more precisely.  And most offer variations in temperature inside the box so that the puppy can move from warm to cooler spots.  

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Ideal environmental temperatures

Week 1:                84 - 89° F -  Humidity should be 55% +/- 10%.

Week 2 & 3:          80 ° F

Week 4:                69 - 75° F

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HYPOGLYCEMIA – Is blood sugar too low?

Young puppies (as well as toy breeds) do not have fully developed bodies to store and regulate blood sugar.  Young puppies also use a great deal of energy doing everything.  Staying warm.  Eating.  Moving.  And as such they use up energy that depletes their blood sugar rapidly.  Additionally, if they are cold, they also are using more energy and making them even more susceptible to hypoglycemia.

 

Symptoms

Without testing you may not know for sure.  But with very young puppies you may see one or more of the following symptoms:

 

Hypoglycemia Symptoms

• Lethargy

• Labored breathing

• Pale gums or tongue

• Tremors, shivering or trembling

• Seizures

• Loss of appetite

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Treatment

Even without obvious symptoms, treating with a source of quick sugar can be the difference between life and death of the puppy.  And while there are specific products for animals like Nutracal, you may use other items that you likely have in your home.  

 

Safe forms of sugar for puppies

• Karo syrup

• Honey

• Sugar or sugar water (1:1 ratio)

• Maple syrup

• NutraCal

 

Frequency of Treatment

If it is obvious that a puppy is crashing from low blood sugar and the puppy is warm enough, begin administering three drops of Karo syrup, honey or sugar water (1:1 ratio) orally every three minutes.  

 

Treating a crash:  3 drops of Karo syrup, honey or sugar water (1:1 ratio) every 3 minutes. 

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Use a syringe if available or your finger to rub the sugar source on the puppy’s gums or tongue.

It may take an hour or more for your puppy to come out of its crash and start to act normally again, so it is vital to keep at it.  Know that even with perfect treatment, some puppies will not make it. 

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Maintenance Mode

If the puppy recovers from the crash but is weaker than normal or other puppies in the litter, continue to provide the sugar treatment before every feeding to ensure their systems are boosted.  Especially if they are a small breed or smaller puppy.  This routine maintenance every couple of hours can help avoid crashes in weaker puppies since they will use so much energy while eating.

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NOTE: Sometimes you may notice a puppy shiver after eating.  The process of digestion can temporarily alter their body temperature, causing a slight chill that manifests as shivering; this is usually normal, especially if the puppy is still young.  This is also common in puppies during weaning when they are adjusting to a new diet.

 

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HYDRATION – Are they dehydrated?

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Causes and Symptoms

Dehydration can cause puppies to feel lethargic and disinterested in eating.  It can also cause their urine to be clear when it should be pale yellow.  Also their gums may be pale and tacky.  A young puppy that has had diarrhea or been vomiting can easily become dehydrated.  Being chilled can likewise cause dehydration.

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Testing Methods

There are two methods for checking your puppy’s hydration.

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Skin Test

One method is to pull up the skin at the base of your puppy’s neck.  When you release the skin, it should “snap” back into place within 1-2 seconds. A delay or “doughy” feeling of the skin may suggest dehydration. Please note that this method can be less accurate for very young puppies whose skin elasticity is variable.

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Gum Test

A more accurate method is to check your puppy’s gums for color and moisture. A well-hydrated puppy’s gums will be pink and moist to the touch. Pale gums or gums that feel dry or tacky to the touch suggest dehydration. You can also assess capillary refill time by pressing gently on the gums. The gums will initially turn pale and then return to normal in 1-2 seconds. If it takes longer than this for the color to return, this is a sign of poor blood circulation which suggests dehydration.

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Treatment

Dehydration should be addressed quickly, especially with very young puppies through:

• Nursing

• Bottle feeding

• Tube feeding

• Fluids – SubQ or IV (1ml of fluids per ounce of puppy weight)

• Pedialyte and/or liver water

 

If the puppy has been vomiting or having diarrhea that may be a reaction to formula or milk and they are dehydrated, substituting electrolytes (aka Pedialyte) for milk until those problems resolve will allow you to rehydrate them.  Preferably children’s unflavored Pedialyte.  There are also dog or puppy versions of electrolyte available on the market.  Breeder’s Edge makes one called Puppy Lyte or you can make your own.   

 

Homemade Pedialyte

1 Cup Water (boiled or distilled)

1 T. Salt

2-3 T. Sugar

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You can bottle feed or tube feed electrolytes as you would formula and at similar amounts to their normal feeding volume.  Again, 1 ml (cc) per puppy weight in ounces.  See FEEDING below for more details.

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INFECTION

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Symptoms & Treatments

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Umbilical infection   – Symptoms would be red, warm, swelling but an infection may not even appear to be present.  Recommend treating each and every newborn puppy's umbilical cord immediately after birth and each day until the cord dries and falls off.  Swab the cord liberally and repeatedly for a few days until cord dries and falls off. 

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Here are the things that you can use to treat the cord:

• Hand sanitizers (if nothing else available)

• Betadine

• Iodine

• Alcohol

• Hibiclens (Over the counter - chlorhexidine Topical Antimicrobial)

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Blue skin on belly, legs or feet can be a sign of infection or sepsis.  Internal injury caused during whelping.   In this instance, see your vet as soon as possible.

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Pneumonia – lungs will sound crackly or raspy.  May see discharge from nose.  Will need antibiotics (Clavamox) at a minimum and may benefit from humidifier, nebulizer treatments and/or oxygen.  Again, see your vet as soon as possible.   Watching closely for dehydration and keep especially warm.

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Eye infections – Check eye areas (even before they open) for swelling or puffiness.  You may even see puss from the corner of the eye when you apply a very gentle pressure.  VERY GENTLY using warm compresses make small circular motions in one direction, then rewarm compress and go the other way.  Do this until a tiny crack opens up where the puss can then drain from the small crack.   Once no more puss is present, you’ll need an eye ointment and antibiotics (likely Amoxi).

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