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  5. What do I need to know about Brachycephalic dogs?

What do I need to know about Brachycephalic dogs?

We know that the human families of brachycephalic, or flat-faced dogs love and cherish these characterful and loving animals. These dogs have great personalities and form strong bonds with their owners. Unfortunately, the exaggerated physical features that often initially draw people to these breeds, like their flat faces, cause these animals health and welfare problems. The noticeable breathing noises that these dogs make, like snuffling, snoring and snorting, is a sign that breathing is very difficult and distressing for the dog, and this realisation is heartbreaking.

Animals with extreme exaggerated physical features may require specialised veterinary care to improve their comfort and quality of life. These pets may also need additional lifelong daily care from their owners. Potential owners should carefully and seriously consider their capacity to provide adequate care for a brachycephalic pet. This includes considering financial circumstances, having access to a specialist emergency veterinary clinic, likelihood of travel or relocation, and participating in an active or busy lifestyle.

Features of brachycephalic animals

Brachycephalic animals have an exaggerated short and wide skull, and their bottom jaw is disproportionately longer than their upper jaw (commonly known as an ‘undershot’ jaw). These abnormalities are a result of selecting features to pedigree breed standards, where the focus has been on physical traits and appearance rather than on traits that will maintain or improve the health and welfare of the animal.

Brachycephalic dogs can suffer from a range of health and welfare issues including breathing problems, digestive issues, eye diseases, difficulty giving birth, spinal malformations, exercise and heat intolerance, sleeping difficulties, skin diseases, and dental diseases [1].

Brachycephalic Obstructive Airway Syndrome (BOAS)

Brachycephalic Obstructive Airway Syndrome (BOAS) is a breed related disorder which results in breathing difficulty which significantly compromises their welfare [2]. BOAS is a lifelong and often progressive disorder that affects an animal’s ability to breathe, exercise, eat, play, sleep, engage in normal behaviours and live comfortably. Some of the breeds affected by BOAS include the French Bulldog, Pug, Boston Terrier, Boxer, and British Bulldog. See these articles for more detail:

BOAS is also thought to increase the risk of air travel for brachycephalic dogs, during which some animals have tragically died. This has resulted in some airlines refusing to accept these animals for air transport or imposing strict guidelines for airline travel due to the high risk of serious health problems and death. See this article for more detail.

Brachycephalic Ocular Syndrome

The flattened brachycephalic head shape commonly includes eye sockets that are very shallow. Their ‘pop eyed’ appearance may lead to various abnormalities of the eye and related diseases due to having shallow eye sockets, which are known collectively as Brachycephalic Ocular Syndrome [3]. Breeds such as Pugs, British bulldogs, and French bulldogs are predisposed to Brachycephalic Ocular Syndrome.

To help prevent these conditions and minimise pain and discomfort, these dogs may need to undergo multiple surgeries, although some of the conformational conditions cannot be corrected by surgery. Instead, frequent or life-long topical eye medications may be needed. Also, blindness can occur long term or if left untreated. See this article for more detail.

Brachy Bug Labelled
Above: A picture of a Pug showing problematic protruding eyes (A), facial skin folding (B) (the skin folds may come into contact with the protruding eyes resulting in irritation), and tear staining of the face (C) which can be a result of abnormal tear production/irritation.

Difficulty giving birth

Many brachycephalic dog breeds have substantial difficulty giving birth, due to the puppy’s head and shoulders being much wider than the mother’s hips and birth canal [4] and the mother may have trouble breathing due to the stress and physical exertion of birthing. This can make veterinary assistance necessary, which may include anaesthetising the mother, then surgically removing the puppies (a caesarean section or C-section). There are significant health risks and negative impacts on both the mother and pups’ welfare. See this article for more detail.

Brachy English Bulldog
Above: A picture of an English Bulldog showing the breed’s characteristic features including their wide head and shoulders and narrow hips.

Tail malformations – “Screw tail”

Some brachycephalic breeds including the British bulldog, French bulldog, Pug, and Boston terrier have a screw tail [56]. A screw tail is a genetic malformation that causes the bony part of the spine forming the tail to have a reduced number of bones (so that it is shortened) and angular fusion of some of the bones (so that it curls or kinks) [7]. Brachycephalic dogs with screw tails have a high likelihood of having other deformities along the length of their spine, which can cause health problems such as nerve problems causing an inability to move normally, pain along the spine, or urinary or faecal incontinence.

Figure 1: 3D scan of normal spine with area corresponding to the abnormal area in Figure 2 circled in green.
Figure 2: 3D scan of abnormal spine of an affected brachycephalic dog with area corresponding to the normal area in Figure 1 circled in red.
Figure 3: Radiograph of normal spine with area corresponding to the abnormal area in Figure 4 circled in green.
Figure 4: Radiograph of abnormal spine of an affected brachycephalic dog with area corresponding to the normal area in Figure 3 circled in red.


The compromised airways of brachycephalic dogs seriously affect their ability to engage in normal dog behaviours. In one study, a third of brachycephalic dogs were unable to walk for more than 10 minutes on a 19°C summer day [8]. This inability to exercise normally can severely restrict the activities these dogs can engage in and share with their owners.

Owners also need to be aware that weight control is extremely important for brachycephalic dogs, as extra weight and obesity can make their breathing problems much worse. Exercise intolerance poses challenges for weight management of brachycephalic dogs. Regular exercise that the individual dog can cope with without struggling to breathe is important, both to help with weight management and to provide opportunities for socialisation and stimulating experiences outdoors. In addition, it is vital to ensure the dog’s diet will keep their weight under control.

Some brachycephalic dogs are unable to sleep normally because their airways become obstructed. Sleep apnoea is when breathing stops during sleep, which can occur in brachycephalic dogs as they lose conscious control of their muscles and their airways become obstructed during sleep [9]. Sleep apnoea affects the ability of affected animals to go into deep sleep for long periods of time, reduces oxygen intake during sleep, and brachycephalic dogs spend more time trying to get to sleep [9], all of which cause distress and anxiety. Brachycephalic dogs regularly wake up whilst sleep, sleep sitting up or with their chin elevated, or sleep with a toy in their mouth so that their mouth remains open to compensate for airway obstruction [8].

Skin Disease

Selection for brachycephalic traits has resulted in these dogs having multiple deep skin folds over various parts of their body, commonly around the face and base of the tail [1]. Consequently, the folding of skin creates a warm and moist environment for fungus and bacteria to thrive causing pain and discomfort. Surgical correction may help to remove the skin folds but in most cases bacterial and fungal treatments are required frequently and long term.

Dental Disease

Brachycephalic dogs may also be predisposed to dental disease. They have a normal number of teeth that must fit into a space that is smaller than normal, as their flattened face reduces the gum area within their mouth. This causes overcrowding of the teeth which increases the risk of food and dirt becoming trapped between their teeth [2]. This leads to overgrowth of bacteria in the mouth causing infection of the gums around the teeth. To help avoid this, owners can provide at-home dental care or in more severe cases, dental surgery by a veterinarian may be required, including tooth extractions to reduce overcrowding in the mouth to try and prevent bacterial overgrowth.

More information

RSPCA Australia and the Australian Veterinary Association are raising awareness to try to change how purebred dogs are selected and bred in Australia. Current and potential owners can play a vital role in helping to improve the welfare and lives of brachycephalic breeds. For more information or to get involved, visit the following websites: Love is Blind, Australian Veterinary Association. See also: American College of Veterinary Surgeons, International Cat Care, Universities Federation for Animal Welfare and UPEI Canine Inherited Disorders Database.


[1] Fawcett A et al (2019) Consequences and management of canine brachycephaly in veterinary practice: perspectives from Australian veterinarians and veterinary specialists. Animals 9 (1).

[2] Ekenstedt KJ et al (2020) Canine Brachycephaly: Anatomy, Pathology, Genetics and Welfare. Journal of comparative pathology 176: 109-115.

[3] Universities Federation for Animal Welfare (2011) Brachycephalic Ocular Syndrome in Pugs (accessed on June 23, 2021)

[4] Universities Federation for Animal Welfare (2011) Dystocia due to Foetal-Pelvic Disproportion in English bulldogs (accessed on June 23, 2021)

[5] Gutierrez‐Quintana R, De Decker S (2021) Tail end of the brachycephalic problem: diagnostic and treatment options for spinal malformations. In Practice 43(3): 124-134.

[6] Lackmann F et al (2021) Epidemiological study of congenital malformations of the vertebral column in French bulldogs, English bulldogs and Pugs. Veterinary Record, 22 May 2021: e509.

[7] Mansour TA, Lucot K, Konopelski SE et al (2018) Whole genome variant association across 100 dogs identifies a frame shift mutation in DISHEVELLED 2 which contributes to Robinow-like syndrome in Bulldogs and related screw tail dog breeds. PLoS genetics 14(12): p.e1007850.

[8] Roedler FS et al (2013) How does severe brachycephaly affect dog’s lives? Results of a structured preoperative owner questionnaire. The Veterinary Journal 198(3): 606-610.

[9] Hendricks JC et al (1987) The English bulldog: a natural model of sleep-disordered breathing. Journal of Applied physiology 63(4): 1344-1350.

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Updated on August 9, 2021
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