Getting puppies and kittens started with a Fear Free™ experience takes an active approach at home and at the vet clinic.
When we see an adorable puppy or kitten for their first visit, it’s a reminder of why we love this profession. They’re often friendly, exploratory, and playful, and can be easily distracted with treats. So how do we go from those trusting puppies and kittens to adult pets who are terrified of us? When we think of vet visits from their perspective, it’s no wonder. Car rides, being handled by strangers, and needle pokes are stressful, and without intervention, can produce pets that have an overwhelming fear of the vet.
Fear Free ™ was founded in 2016 and strives to protect the emotional health of pets. Not only does this approach show more compassion for our patients; it also provides more compassion for us as veterinary caregivers, because patients with a lower fear of the vet are easier for us to handle, resulting in better patient care. Getting puppies and kittens started with a Fear Free experience takes an active approach at home and at the vet clinic.
The body language of fear, anxiety and stress
Think back to the first time you got bitten or scratched by one of your patients. Did it seem to happen out of nowhere? Pets are communicating to us all the time, whether we realize it or not, often nonverbally. When we fail to recognize the signs of fear, anxiety, and stress (FAS) and adjust our handling, injury to us or the pet can result. FAS also has numerous negative effects on a pet’s physical health,1-5 and understanding body language will help us minimize it.
Similar to learning a foreign language, learning the body language of FAS in dogs and cats is eye-opening. You’ll start to see pets broadcasting their FAS all the time, on your TV screen and at the dog park, and wonder why everyone else seems oblivious. Puppies and kittens don’t often growl or hiss, but it’s not uncommon for them to freeze, move away, or stop eating treats when they get stressed. Taking a few minutes to learn about subtle signs of FAS is vital for a Fear Free puppy and kitten visit, and provides valuable feedback about when to change our approach. These signs are encapsulated wonderfully in the illustrated posters created by the late Dr. Sophia Yin6, 7 and through Fear Free Pets,8 and should be handed out with all puppy and kitten kits.
Incorporating behavior into puppy and kitten visits
Between discussions about vaccines, preventatives, diet, and spaying/neutering, it can be hard to find time to think about behavior. But as with adult pets, everything and everyone a young pet encounters at the vet influences them in some way, often negatively. If we want to counteract that stress and set them up for success for future vet visits, we must consider behavior and emotional health during puppy and kitten visits. Those happy-go-lucky puppies/kittens may not stay that way if they encounter scary and aversive experiences at the vet, and already fearful puppies/kittens will likely get worse.
Here are some steps you can take towards ensuring a Fear Free experience during appointments:9
Use positive reinforcement during every visit. Positive reinforcement helps lower FAS and allows us to bond with our patients. It’s not enough to have a jar of giant dog biscuits in exam rooms. Stock a variety of delicious treats10 for both cats and dogs, and create a toy drawer to help encourage play. From the moment a pet enters the clinic until the moment they leave, offer a small (pea-sized or smaller) treat every few seconds, especially during handling. Better yet, ask the client to feed treats so you can demonstrate the value of Fear Free while continuing your exam and vaccines. Clients love giving treats as much as pets love eating them, and most puppies and kittens can be easily distracted for vaccines while eating a blob of squeeze cheese or Churu.
Minimize pain and practice compassionate handling. No one likes being poked with needles, and a 22g needle can seem gigantic to the two-pound puppy or kitten you’re vaccinating. Pain is a huge contributor to FAS, so use fresh 25g needles and apply a thin layer of a lidocaine numbing cream such as Supernumb to planned vaccination sites or blood draw sites for feline retroviral testing at the beginning of the visit. Similarly, handling patients roughly increases their FAS, so use a less-is-more approach and adjust your technique if signs of stress are seen.
Use non-slip mats and towels. The fear of falling can be profound, and we see it every time we put a pet on a slippery scale or exam table as they freeze or start tap dancing in panic. Providing a stable surface for puppies and kittens will lower their FAS, and a cozy towel can be sprayed with Feliway11 or Adaptil12 to further lower stress.
Treat early, when fear levels are mild. We routinely use anxiolytics for adult pets with a fear of the vet, so why not consider them for fearful puppies and kittens? If a puppy/ kitten is hiding, refusing to eat treats, or trembling, their FAS level will likely get even worse over time without intervention. Just as weight management is easier for a pet with a body condition score of 6/9 than one with a BCS of 9/9, don’t wait until a puppy/kitten is showing high levels of fear before recommending medications to help reduce stress. Clients who are resistant to anxiolytic medications may be open to trying supplements such as Zylkene,13 or to using other ways to lower FAS, such as bringing their own treats to vet visits and covering the cat carrier with a towel.
Schedule all puppy/kitten booster appointments as doctor’s appointments. Many clinics schedule some of these as tech appointments if there are no health concerns from the client, but how often have you found a new mass or an ear infection on an adult pet during your exam?
Even if the puppy/kitten is physically healthy, these are opportunities to assess their level of FAS during the appointment, and to provide positive reinforcement at the vet clinic. If a puppy/kitten was a little nervous at their first visit and is now hiding and refusing to interact, that should be a red flag that further discussion is warranted. Don’t be afraid to recommend additional veterinary visits to work on behavior at the clinic once the puppy and kitten booster series is completed.
Ask about behavior at home. Unfortunately, behavior seems to be one of the least-liked and most-avoided areas among veterinarians in general practice. It rarely offers easy solutions, like a course of antibiotics for pyoderma, and it requires staff and client commitment. As a result, questions about behavior and training often get glossed over in the exam room, leading clients to get advice online or from friends, family, or trainers. If those sources are using aversive techniques such as punishment, clients who adopt those methods can inadvertently increase fear in their pets. Behavioral causes have been cited as the most common reason why pets are relinquished to shelters,14 so troubleshooting issues with housetraining, biting, and anxiety at puppy/kitten visits will increase pet retention.
Fear Free ™ client education for puppies and kittens
We only see our patients for brief periods during their lives, and getting clients involved with their behavioral health is essential to success with Fear Free. This is especially true for puppies and kittens as they move through key stages of their development.
The socialization period typically occurs between three to 12 weeks in puppies and two to seven weeks in kittens,15,16 and it’s during this time that our young patients are most open to new experiences. Since this window of time is so small, we should encourage all clients to enroll their pets in puppy and kitten socialization classes early, starting a week after their first vaccines and deworming.17 The fear of canine parvovirus looms large for clients, but studies have shown that puppies enrolled in socialization classes have a higher rate of retention in the home and were no more likely to be infected with CPV.18, 19 Socialization classes are not obedience classes; rather, they expose the puppy or kitten to others in their age group in a positive and controlled environment. Questions about training and common behavioral concerns can also be addressed during these classes, and all family members should attend.
Socialization with people is also integral at this stage, and these classes expose puppies and kittens to people outside the home. Clients should strive to have their puppies or kittens meet 100 people in 100 days. This includes people of different ages, genders, and ethnicities, and interactions should be positive. Allowing shy puppies and kittens to approach on their own and receive a treat will reward them for confident behavior.
Clients should also be instructed to desensitize and counter condition their puppies and kittens to general handling at home. Many pets dislike having their ears, mouths, paws, tails, and abdomens touched, and positive reinforcement training will reduce FAS when those areas are handled at home and at the vet. Puppies and kittens should also be taught to accept veterinary-specific handling, such as restraint and having their skin lifted for vaccines.20, 21, 22, 23 Resistance to restraint is common and makes vet visits much more stressful for the pet and veterinary staff, so start training early. Dr. Yin’s socialization and handling checklists24,25 should also be included with all puppy and kitten kits so the client can work through training at home and identify problem areas.
Puppy and kitten appointments are about more than cuddling and vaccines. By adopting Fear Free practices and proactively educating clients, we can make a huge impact on our patients’ emotional and physical health throughout their lives.
1 Tanaka A, Wagner DC, Kass PH, et al. Associations among weight loss, stress, and upper respiratory tract infection in shelter cats. J Am Vet Med Assoc 2012;240(5):570-576.
2 Buffington CAT, Pacak K. Increased plasma norepinephrine concentration in cats with interstitial cystitis. J Urol 2001;165(6 Pt 1):2051-2054.
3 Buffington CAT, Teng B, Somogyi GT. Norepinephrine content and adrenoceptor function in the bladder of cats with feline interstitial cystitis. J Urol 2002;167(4):1876-1880.
4 Cameron ME, Casey RA, Bradshaw JWS, et al. A study of environmental and behavioural factors that may be associated with feline idiopathic cystitis. J Small Anim Pract 2004;45(3):144-147.
5 Bhatia V, Tandon RK Stress and the gastrointestinal tract. J Gastroenterol Hepatol 2005;20(3):332-339
9 Lloyd JKF. Minimising Stress for Patients in the Veterinary Hospital: Why It Is Important and What Can Be Done about It. Veterinary Sciences. 2017; 4(2):22. https://doi.org/10.3390/vetsci4020022.
11 Pereira JS, Fragoso S, Beck A, Lavigne S, Varejão AS, da Graça Pereira G. Improving the feline veterinary consultation: the usefulness of Feliway spray in reducing cats’ stress. J Feline Med Surg. 2016 Dec;18(12):959-964.
12 Denenberg S, Landsberg GM. Effects of dog-appeasing pheromones on anxiety and fear in puppies during training and on long-term socialization. J Am Vet Med Assoc. 2008 Dec 15;233(12):1874-82.
13 Beata C, Beaumont-Graff E, Coll C, et al. Effect of alpha-casozepine (Zylkene) on anxiety in cats. J Vet Behav: Clin App Res 2007;2(2):40-46.
14 Miller DD, Staats SR, Partlo C, et al. Factors associated with the decision to surrender a pet to an animal shelter. J Amer Vet Med Assoc 1996;209:738-742.
15 Freedman DG, King JA, Elliot O. 1961. Critical periods in the social development of the dog. Science, 133, 1016-1017.
16 The effects of early and late handling on the attachment of cats to people. Karsh EB. In Anderson RK, Hart BL, Hart LA (eds): The Pet Connection, Conference Proceedings-St. Paul: Globe Press, 1983, pp 207-215.
17 https://avsab.ftlbcdn.net/wp-content/uploads/2019/01/Puppy-Socialization-Position-Statement- FINAL.pdf
18 Duxbury MM, Jackson JA, Line SW, Anderson RK. Evaluation of association between retention in the home and attendance at puppy socialization classes. JAVMA. 2003;223(1):61-66.
19 Stepita ME, Bain MJ, Kass PH. Frequency of CPV infection in vaccinated puppies that attended puppy socialization classes. JAAHA. 2013;49(2):95-100.