The first days of a foal's life can be risky; there are a number of things that can go wrong. Some problems can be dealt with easily (such as constipation), while others are life-threatening (such as a ruptured bladder).

In this article, Bonnie Barr, VMD, Dipl. ACVIM, an internist at Rood and Riddle Equine Hospital in Lexington, Ky., Jennifer Davis, DVM, PhD, Dipl. ACVIM, Dipl. ACVCP, an assistant professor of equine medicine and pharmacology at North Carolina State University, and Debra Sellon, DVM, PhD, a professor of equine medicine at Washington State University, give advice on the most common foal problems the horse breeder might face.


Monitor the foal through his first day of life to make sure he passes the meconium (a dark greenish mass that accumulates in the bowel during fetal life and is discharged shortly after birth). Colostrum acts as a laxative to stimulate the gut, but sometimes hard fecal balls are difficult to pass.

"The foal may strain to defecate and may become distended (have a bloated abdomen) and colicky," says Barr. "He may act like he wants to nurse, but won't, because of discomfort."

The foal might root at the udder and you'll think he's nursing, but you need to watch and make sure he does. He might come away from the mare and his head will be wet, because he was merely butting the udder and the mare was streaming milk all over him.

Barr says, "Treatment for constipation is generally an enema--a little soapy warm water. Most of these foals do fine (fecal balls soften up and are more easily passed). At the other extreme, sometimes at the clinic we get a foal in which the tract is so blocked we must hold him off milk and supplement him with a dextrose solution until that material works through.

"Sometimes we give foals a retention enema to keep the fluid in longer (for about 20 minutes) to soften up the hard material," she adds. "We use a drug called acetylcysteine that helps to break down the fecal material. This is something your veterinarian can do."

Sellon says you shouldn't routinely use a human enema product. "Many contain phosphate, and if you give several of these, you may overdose the foal on phosphate," she warns. "Talk with your vet, especially if the foal becomes colicky. The most common cause of colic in a foal 24 hours old or less is meconium impaction, but there are other causes which may be more serious."

Failure of Passive Transfer

"Make sure the foal nurses or gets colostrum via bottle or tube, then make sure there is an adequate IgG level (immunoglobulin G, the main immunoglobulin in the mare's colostrum)," says Barr. This indicates if the foal absorbed the antibodies from the colostrum. "If the foal doesn't get adequate colostrum, he is more at risk for septicemia, diarrhea, pneumonia, infected joints or umbilicus, etc., as possible secondary complications."

Check IgG levels 18 to 24 hours after a foal is born, while you still have a chance to correct them, says Sellon. If they're low, you can give an alternate source of colostrum, or plasma that contains antibodies the foal can use, depending on the situation.

Davis says there's an easy test to measure levels of IgG in the foal's blood serum.

"It's called a SNAP test ( and takes about seven minutes, with a color change you look for to tell whether the foal has less than 400 mg/dl IgG, 400 to 800, or greater than 800," says Davis. "A foal with less than 400 mg/dl IgG is considered to have complete failure of passive transfer and needs antibodies. Foals in the 400 to 800 range can be retested later to see if they are still getting more antibodies from the colostrum, or you can give them extra at that point. Foals greater than 800 are usually fine. Plasma is fairly expensive, but if you are looking at a $200 plasma infusion versus the loss of a valuable foal, it's worth it," she says.


Infections that travel through the body, affecting multiple systems, can quickly become life threatening unless halted. Infections spread via the circulatory system can originate from the digestive tract (ingested pathogens) or umbilicus (which is open to environmental pathogens). The latter route is an open doorway if the foal is born in a dirty environment and the umbilical stump becomes contaminated before you can apply a disinfectant to protect it.

"Any foal that didn't get enough colostrum can be at risk for septicemia--an overwhelming bacterial infection," says Barr. "The foal with septicemia will be dull and depressed, not wanting to nurse. Sometimes bacteria will localize in the lungs, a joint, or umbilicus; the foal should be put on antibiotics to help fight the infection."

Anytime a foal gives any hint of dullness, spends too much time lying down, or is "not quite right," have your veterinarian check him. With an adult horse, you can often take a "wait and see" attitude to determine if it gets better or worse, but you can't with a foal.

"They can become critical quickly," advises Barr.

These foals are often normal at birth and become depressed one to two days later, but a few are sick at birth.

"This can happen if the mare had placentitis or was sick during pregnancy and bacteria or toxins entered the foal via the bloodstream," says Davis.

"It is very important that septic foals receive glucose, because they aren't nursing," she adds. "It should usually be given IV because the bacteria in the system use up glucose as well. The foal may become comatose or have seizures from lack of glucose.

"We can culture a blood sample, but this usually takes a few days (to grow the culture), so the foal is started on broad spectrum antibiotics until we know what we are dealing with," notes Davis. "We must treat very aggressively to fight the infection and inflammation, and support the foal nutrition-wise."

The best preventative is to make sure the environment (foaling area) is as clean as possible, and that a foal nurses soon after birth.

"Clean up the mare before foaling, and wash her udder, flanks, and hind legs again before the foal nurses the first time," Barr says.

Umbilical Infection

The umbilical stump should be disinfected right after birth (and a couple times a day until it dries up and falls off) using a chlorhexadine or dilute Betadine solution, says Davis. Don't use tincture of iodine; it's caustic and irritating and might keep the area raw.

If at any time the navel area becomes hot, swollen, painful, starts dripping urine, or shows evidence of pus, consult your veterinarian. Infection might be localized, and it could spread to the bladder or spread all the way up to the kidneys or liver (and the foal might develop abscesses in the liver). The infection might get into the bloodstream and create a general sepsis, or settle in any of the joints. The foal will need antibiotics, and he might need an abscess surgically removed or his joints flushed. The earlier treatment is started, the better the chances for a successful outcome.

Ruptured Bladder

This is most common in male foals and usually occurs during birth; the bladder ruptures on the way through the mare's pelvic canal.

"These foals look normal at birth, but as urine begins to build up in the abdomen, electrolyte imbalances can become fatal," says Davis. "Blood potassium goes very high and the sodium and chloride become very low."

In these foals the belly becomes distended and the foal strains to urinate. He might pass urine (if the rupture is just a slow leak into the abdomen, the bladder can still fill and empty normally) or merely dribble it. He might be colicky.

As urine builds up in the abdomen, the foal becomes depressed and stops nursing. Ruptured bladders can be surgically repaired, but if they are not recognized early, the electrolyte imbalance can be so severe that this must be corrected first (which can take days) or the foal won't make it through the anesthesia, says Davis. By that time there's also serious peritonitis (inflammation of the abdominal wall).

A ruptured bladder case can have a good outcome if treated early, but otherwise, prognosis is poor.

Monitoring your foal's urine output can indicate a bladder rupture, but it also can give you a clue about a foal that isn't nursing as it should. According to Sellon, the foal that is nursing regularly and getting plenty of milk will urinate almost every time he suckles.

"When he gets up from his nap he will suckle, then urinate," she says. "The urine should look pale and watery--very dilute. If it's dark, thick, or the foal is not urinating very often, that's a sign he's not drinking enough and should trigger a call to your veterinarian."

Dummy Foal

This problem is also called hypoxic encephalopathy or neonatal asphyxia. The foal becomes short on oxygen at some point during birth, either from a long or difficult birth or the cord breaking too soon. It might happen if the membranes don't come off the foal's nose soon enough (he nearly suffocates). If the mare has a red bag delivery (the placenta detaches and comes ahead of the foal), there is risk for having a dummy foal. The foal might seem normal for the first day or two, then become dull.

"You need to be very observant of the foal for the first few days," says Barr. "If you notice that on Day 2 the foal is not nursing, seems a little quiet, and is hanging its head, consult your vet.

"I've seen foals that seemed normal at first, after a red bag delivery, but 24 to 36 hours later the foal was down and having seizures," she explains. "Many people think that with a red bag foal/dummy foal you'd see the problem right away, but this isn't always the case. The foal might be able to get up and nurse, but the next day he might be just standing in the corner."

Davis says when the brain is deprived of oxygen, it starts to shut down. "When the oxygen level rises again in the body and blood supply returns to the brain, everything starts to swell; fluid comes out of the bloodstream and into the brain, creating cerebral edema," she says. "It's not necessarily the lack of oxygen that causes clinical signs, but oxygen return.

"It's a serious situation, because a foal that can't nurse can't take in any nutrients," Davis continues. "If blood glucose drops very low, there is further brain damage because glucose is the only nutrient the brain can use. These foals tend to get hypoglycemic (their blood sugar drops), then become comatose or seizure. This is why we may start treatment early if we know a foal had a difficult birth or red bag delivery, to head off the worst problems."

Sellon says this situation has a fairly good prognosis if the foal is treated with drugs to reduce swelling in the brain and given supportive treatment (feeding care) until the brain has a chance to heal.

"Feeding care is very important because the foal can't eat, and can't go very long without nutrition," she advises. "There may be damage in other parts of the body besides the brain; the foal may need IV feedings for a few days until the GI tract heals, as well."

Neonatal Isoerythrolysis

This is also called jaundice. Sometimes a foal inherits from its sire a different blood type than the dam. This makes its blood incompatible with that of the mare, and the mare makes antibodies against the foal's red blood cells. This does not affect the foal until after he is born and drinks her colostrum that contains antibodies.

"In this instance, the foal would be normal at birth, but you'd notice problems soon after," Barr says. "How soon signs appear would depend on how many antibodies were in colostrum, how much colostrum the foal drank, etc. This would be the only instance in which it is not beneficial for the foal to get high levels of antibodies from his dam. The foal needs colostrum from another source instead."

The foal is fine at first, then he becomes weak and lethargic after nursing. Respiration and heart rates rise. The membranes of his mouth become very pale or yellow, and the whites of his eyes might look yellow due to breakdown of the red cells by the antibodies.

"The maternal antibodies cause the foal's red blood cells to burst," explains Davis. "Then the foal has very few normal red cells to carry oxygen to the body tissues and brain."

The hemoglobin released from the destroyed cells can be toxic to the kidneys. Some foals will need a blood transfusion to survive.

The foal should be fed another source of milk or colostrum for a day or two, and the mare should be regularly milked out until all her colostrum is gone. Then the foal can safely nurse her again.

"Often you don't notice the problem, however, until the damage is done, when the foal is a day or two old," says Barr. "By then the mare may not have much colostrum left in her milk."

If you have a mare that had this problem before, you can test her to see if there will be an incompatability between her blood type and that of the foal. Sellon says a lot of big farms have neonatal isoerythrolysis prevention programs--blood typing and checking colostrum--so they know whether or not to let the foal nurse its dam when it's born.

Barr tells breeders that if they've had a foal with this problem, the mare might have difficulties with subsequent foals.

"If you are unable to do any testing, I recommend muzzling the foal and putting it on an alternate source of colostrum when it is born," she states. "Strip the mare out for the first one to two days, until you feel comfortable that her milk has no more colostrum (antibodies) in it. The foal should be fed a milk replacer until it can go back to the nursing mare. I usually give the foals antibiotics just because they may not have gotten adequate passive transfer from your alternate source of colostrum. Your veterinarian may want to give them a liter of plasma, too."

Angular Limb Deformities

Barr says the most common limb abnormalities are contracted tendons at fetlock joints or knees. The knees or fetlocks might buckle forward.

"Most of them straighten up on their own in a few days," she says. "If they are bad, people sometimes give these foals oxytetracycline in the first couple of days of life to relax the tendons. Some people put splints on the legs.

"Some foals have the opposite problem; tendons and ligaments are so lax that the knee goes backward," Barr adds. "People often want to put bandages on them to support the joint, but that's usually not a good idea. As those foals get stronger and move around more, the ligaments and tendons will strengthen and tighten up."

Sellon says splints can be tricky in young foals. "Their skin is so thin that if splints are not applied correctly and closely monitored, you'll cause problems," Sellon says. "But if fetlock joints drop so low the foal is walking on the back of the pastern, and the skin is rubbing the ground, they rapidly get sores and the joint may open up."

When faced with a serious limb problem, consult your veterinarian for ways to treat and correct the deformity. Surgery can be an option for knee or fetlock joints that bow outward or inward if they do not straighten by a certain time. As a general rule, windswept foals (which causes only both rear legs to be abnormally angled, but in the same direction, as if blown that way by a strong wind) straighten on their own, as do lax tendons in fetlock joints (where the joint drops toward the ground).

Knees and fetlock joints cocked inward or outward, however, sometimes need help (via periosteal stripping or transphyseal bridging surgeries) if they're severe enough that they won't straighten on their own. Your veterinarian can assess these and monitor their progress, then determine whether surgical intervention is needed.

Premature Foal

The premature foal might be small and not able to get up. Davis says foals are considered premature at less than 320 days of gestation.

"The dysmature foal can be harder to diagnose because gestation length is normal, but something happens in utero to prevent the foal from maturing completely-- either an infection, or thickened placenta (from fescue toxicity) that did not deliver nutritients as well as it should," says Davis. "These foals look premature; they may have a silky hair coat and floppy ears, lax tendons and joints, and their lungs may not be fully developed. They have difficulty breathing and are susceptible to pneumonia. They have difficulty standing because tendons are weak, and the bones in their joints may not be completely formed and may crush when they bear weight."

Consult your veterinarian for prognosis and care.

Take-Home Message

Discuss with your veterinarian ahead of time the things you should watch for in a newborn foal, and what should trigger a call to your practitioner. Your careful observation is the best protection for your new baby.

About the Author

Heather Smith Thomas

Heather Smith Thomas ranches with her husband near Salmon, Idaho, raising cattle and a few horses. She has a B.A. in English and history from University of Puget Sound (1966). She has raised and trained horses for 50 years, and has been writing freelance articles and books nearly that long, publishing 20 books and more than 9,000 articles for horse and livestock publications. Some of her books include Understanding Equine Hoof Care, The Horse Conformation Handbook, Care and Management of Horses, Storey's Guide to Raising Horses and Storey's Guide to Training Horses. Besides having her own blog,, she writes a biweekly blog at that comes out on Tuesdays.

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