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A few years ago, I had the opportunity to engage in a thought-provoking discussion on a social media forum, where the primary topic was neonatal resuscitation in puppies.

The conversation was initiated by a pertinent question that many breeders and pet owners often grapple with:

“What is the best technique to free the airways of newborns after birth?”

Clearing the airways of newborn puppies immediately after birth is crucial for their survival.

This process removes amniotic fluid – the fluid that surrounds the puppy in the mother’s womb – and stimulates breathing, making sure the puppies can take in the oxygen they need. Without this vital step, puppies may struggle to breathe, leading to hypoxia – a condition where not enough oxygen reaches the body’s tissues – or even death. Hence, it’s a critical part of neonatal care – care given to newborn animals – in dogs.

This query sparked a lively debate among participants, each bringing their unique experiences and knowledge to the table.

Various techniques were described in the comments, their effectiveness, and safety, aiming to find the most reliable and efficient method to ensure the well-being of these newborn pets right after birth.

In my opinion that was a very good question: in neonatology (whichever species you focus on), airways must always be considered. This is something we are reminded of by the APGAR scores that are used in human (and canine) obstetrics!

APGAR scores are a quick way doctors check a baby’s health right after birth – they are seen as the “gold standard” to evaluate a newborn’s health in human medicine.

The name APGAR is an acronym where each letter stands for a different health sign: Appearance, Pulse, Grimace, Activity, and Respiration. Respiration, or breathing, is the ‘R’ in APGAR. It’s just as important for puppies as it is for babies.

If a puppy isn’t breathing well right after birth, it can’t get the oxygen it needs to stay healthy and strong. That’s why clearing a puppy’s airways is always a top priority.

As I scrolled through the initial comments on the forum, a wave of concern washed over me.

One of the comments detailed a method of swinging puppies to remove excess fluids from their airways.

It went like this:

“After birth, hold the puppy securely in your hands, ensuring you’re supporting its head and body. Then, gently swing the puppy downwards in a swift, yet controlled motion. The force of gravity helps to expel any remaining fluid in the airways. Repeat this a couple of times until you hear the pup start to breathe or cry. It’s worked for me every time!”

This brought back memories of a distressing experience I had years ago. It seems these individuals haven’t had the same unfortunate encounter that I did.

Let me share with you guys my story

The Perils of the Past: Unpacking the ‘Swinging’ Technique”

In the early days of my veterinary career, I worked alongside an experienced vet tech who had been in the field for over 40 years.

Her training and practices were steeped in the traditions of a bygone era, including her method of resuscitating newborn kittens and puppies.

During a Caesarean section, she was often tasked with neonatal resuscitation.

Her approach was to swing the newborns to clear any fluids that might have accumulated in their airways.

Indeed, her method did remove these extra fluids. There was no disputing that.

However, her technique was vigorous, perhaps excessively so. She put a lot of energy into her swinging…

One particular incident that stands out in my memory was when I noticed some puppies nose-bleeding after she had swung them. And nose-bleeding can be a sign of trauma… It was a distressing sight, and it raised concerns about the safety of the swinging method.

We monitored these puppies closely in the following days, and I’m relieved to say they all recovered well. But the incident served as a stark reminder of the potential risks associated with outdated practices and the importance of continually updating our knowledge and techniques in veterinary medicine.

And at this time, there were lots of discussions on the “shaken baby syndrome” in humans.

Shaken Baby Syndrome occurs when an infant is violently shaken.

This violent motion can cause the baby’s brain to bounce back and forth inside the skull, leading to bruising, swelling, and bleeding in the brain.

This can result in severe brain damage with long-term consequences such as intellectual and developmental disabilities, physical impairments, seizures, and vision problems.

In severe cases, it can cause life-threatening injuries or even death.

We had concerns… so we decided to banish this technique from our surgical block. 

And we never went back to it.

Never ever.

A Case for Change: The Dangers of Shaken Puppy Syndrome

Few years later this paper was published, clearly describing the consequences of what became the “shaken puppy/kitten syndrome”:

Titled “Intracranial trauma in a dog due to being ‘swung’ at birth”, it presents a case of a male Labrador Retriever neonate that experienced seizures 8 hours after birth.

The puppy was swung at birth to clear amniotic fluid from its airways, a practice that, as mentioned earlier, was common in neonatal resuscitation.

However,it developed a subdural hematoma, a condition where blood collects between the brain and its outermost covering, and intracerebral hemorrhage, bleeding within the brain itself.

These findings were consistent with high-velocity deceleration trauma, similar to “shaken baby syndrome” in humans.

The authors concluded that traditional neonatal resuscitation via swinging is a potentially lethal practice that can induce significant brain trauma in canine neonates.

These findings underscore the potential dangers of the swinging technique, reinforcing the need to abandon this practice in favor of safer methods for clearing the airways of newborn puppies after birth.

Safer Techniques for Neonatal Resuscitation in puppies

So, what are the safer alternatives to swinging?

Thankfully, there are numerous methods that are both effective and gentle.

And here is the one I recommend, which is not only safer but also less stressful for the newborn, ensuring they start their life on a healthy note:

–          Vigorous massage of the thorax of the puppy

One effective method to stimulate breathing and circulation in newborn puppies or kittens is through vigorous massage of their chest or thorax.

Using a soft material like a paper towel, gently but firmly rub the chest area in a circular motion.

This action can stimulate the heart and lungs, encouraging the newborn to take its first breaths, while also helping to clear any remaining fluid from the airways.

It’s a simple, safe, and effective technique that can make a significant difference in those crucial first moments of life.

–          + Aspirating the content of the oral and nasal cavity with a suction

And there is an additional, yet crucial next step: aspirating, or suctioning, the contents of the oral and nasal cavity.

This involves using a small, soft bulb syringe or a similar device to gently suction out any fluid or mucus that may be obstructing the puppy’s airways.

This procedure helps clear the path for their first breaths, reducing the risk of breathing difficulties or complications.

It’s a simple, yet crucial step in ensuring the newborn’s well-being right after birth.

Charting a Safer Path for Puppy Neonatal Care

Over the years I spent in clinic, I consistently used these safer methods for neonatal resuscitation, and I’m pleased to report that I haven’t seen a single instance of a puppy or kitten nose-bleeding again.

Despite the evidence, I’m aware that the “swinging” technique continues to be practiced in some circles.

I’ve heard many argue that they’ve been using this method for years without any noticeable issues. To them, I say, it’s a game of chance, and they’ve been fortunate so far.

However, we now have concrete evidence that the swinging technique can cause serious harm to newborn pets. It’s not just about what we’ve been lucky enough to avoid; it’s about what we know can happen. The risk of causing intracranial trauma, similar to shaken baby syndrome in humans, is real and significant.

Fortunately, we’re not left without alternatives. We have methods that are not only effective but also considerably safer. These include vigorous thoracic massage and aspiration of the oral and nasal cavities, techniques that prioritize the safety and well-being of these newborn animals.

As professionals, our goal should always be to provide the best care possible, using methods that are evidence-based and prioritize the health and safety of the animals we serve.

It’s time we leave outdated and potentially harmful practices behind and embrace safer, more effective techniques for neonatal resuscitation.