The First Months & What the Vet Finds

The first visit, and a calmer way to read it

A puppy’s first several months are, biologically, a construction site. The jaw is lengthening on its own schedule. The heart is keeping pace with a body that is doubling in size. Teeth are arriving and leaving. Testicles are still finishing a journey that began before birth. A belly-button opening is still deciding whether to close. Against that backdrop, a long list of “findings” is not a sign that something has gone wrong — it is a snapshot of work in progress, taken at a single moment, by someone whose job is to notice everything.

That is worth holding onto, because the structure of a veterinary exam practically manufactures anxiety. A good vet is paid to find things. They will tell you about the soft murmur and the slightly inverted tooth and the squishy belly button not because any one of them is alarming, but because noticing and documenting is the job. The skill you need as an owner is not medical — it is interpretive. It is learning to hear “here is something I’m tracking” without translating it into “here is something that is wrong.”

Throughout this guide, two questions do most of the work of separating the routine from the real. The first: is this causing the puppy harm right now? A bite that dents the palate is causing harm; a bite that merely looks imperfect is not. The second: has the age that decides it passed? A testicle that has not descended at twelve weeks still has time; the same finding at seven months does not. Almost every section below is, underneath, an answer to those two questions for one specific finding.

A spectrum, not a verdict

It helps to picture early findings on a band that runs from “cosmetic, will resolve itself” at one end to “act now” at the other. The same anatomical finding can sit at different points on that band depending on one or two details — a hernia’s size, a murmur’s loudness, whether a tooth is touching the palate. Learning to place a finding on the band is more useful than memorising a list, because it is the placement, not the label, that tells you what to do.

The other thing this band makes visible is that the far-right column is thinly populated. Genuine early-puppy emergencies exist — a strangulated hernia, a seizing puppy, a puppy crashing from dehydration — and Section XI gives them the attention they deserve. But they are the exception. The centre of gravity of the whole picture sits in the two middle columns: things you watch, and things you plan a routine fix for. Keep that shape in mind as we go finding by finding.

The mouth: bites, base-narrow canines, and baby teeth

The mouth is where new owners meet their first finding most often, because a puppy’s bite is genuinely a moving target. Puppies have 28 deciduous (baby) teeth, all in by about twelve weeks; the permanent set of 42 arrives over the following months. Crucially, the upper jaw (maxilla) and lower jaw (mandible) grow independently, and each can have its own small growth spurts. A mild misalignment at ten or twelve weeks may simply be the two jaws temporarily out of step — a snapshot of a process that has not finished.

Base-narrow canines: the finding worth understanding

The specific dental finding that worries owners most — and the one in the exchange that prompted this essay — is the base-narrow or linguoverted lower canine. In plain terms: a lower canine tooth that tilts inward and points at the roof of the mouth instead of sitting comfortably outside the gum. It happens for two main reasons. Either the jaw is normal length but the canine erupts too upright and angled inward, or the lower jaw is a touch short (an overbite relationship), which traps the lower canines inside the uppers as they come in.

Here is the honest, two-handed version of the science, because it matters. On one hand, in a mild case, monitoring as the adult teeth erupt is entirely reasonable — and is what a good vet will recommend — precisely because the jaws are still growing and the picture can change. On the other hand, the thing to watch alongside “monitor” is whether the tooth is actually traumatising the palate. A canine that dents or ulcerates the roof of the mouth is causing harm now, and that contact trauma — not the cosmetic angle — is the trigger to act sooner.

The reassuring numbers sit alongside that. The permanent canines do not erupt until roughly five to seven months of age, and the deciduous canines usually give way around the same time, so there is real runway for the picture to change before anyone needs to intervene. The standard plan is a careful recheck as the adult canines come in — around six months — with the palate watched in the meantime. Most of the time, the recheck is simply a recheck.

Retained baby teeth, and the rule of one space

A close cousin of the bite finding is the retained deciduous tooth — a baby tooth, most often a canine, that has not fallen out as its adult counterpart comes in. The governing principle in veterinary dentistry is memorable: no two teeth should occupy the same space at the same time. A baby tooth that lingers can crowd the erupting adult tooth into the wrong position and trap debris against it. The usual plan is to watch through the active eruption window and, if a baby tooth is still present and stubborn, to remove it — conveniently, at the time of spay or neuter. Any deciduous tooth still present beyond about six to seven months should be evaluated for extraction.

The reproductive findings: the testicle that has not dropped

In a male puppy, one of the most common early findings is a testicle that cannot be felt in the scrotum. Before birth, the testicles form near the kidneys and migrate down through a passage called the inguinal canal, guided by a cord called the gubernaculum. In most puppies the journey is complete by six to eight weeks. When one (or, less often, both) has not arrived, the finding is noted — and the clock, not the snapshot, is what matters.

So the honest framing for an owner is this. Before about six months, a single undescended testicle is a genuine wait-and-watch: there is nothing to do day to day, no exercise or massage that helps, and it either completes its journey on its own timeline or it does not. Descent after four months is uncommon, so optimism should be measured — but the door is not closed until roughly six months. That age is the decision point: if it has not descended by then, it is time for a real conversation about next steps.

Why act at all, if the testicle is not painful? Two reasons, both well established. A retained testicle sits at body temperature rather than the cooler scrotum, and over years that carries a substantially raised risk of testicular cancer — and a separate risk of torsion, a painful twisting emergency. The standard recommendation is therefore to remove the retained testicle (and neuter) once cryptorchidism is confirmed. There is no medical treatment that reliably brings a testicle down, and hormone injections are not endorsed.

A brief note on the female counterpart, since it generates its own worried calls: juvenile (puppy) vaginitis — a little cloudy discharge and some licking in a young female — is common, usually mild, and typically resolves on its own around the first heat without antibiotics. It belongs firmly in the “note it, watch it” column unless there is straining, blood, or signs of a urinary infection.

The belly button: umbilical and inguinal hernias

Run a finger down the midline of a puppy’s belly and you may feel a small, soft, squishy bulge at the navel. That is an umbilical hernia — a spot where the umbilical ring, the opening through which the umbilical vessels passed before birth, did not fully close. A little abdominal fat pushes through the gap and makes a soft swelling that often pops out more when the puppy stands, strains, or cries. It is one of the most common findings on a first puppy exam; by one estimate it appears in roughly two to three percent of puppies, and most vets see them regularly.

The detail that decides where an umbilical hernia sits on the spectrum is whether it is reducible — whether the bulge can be gently pushed back into the abdomen. A small, soft, reducible hernia that contains only fat and does not bother the puppy is a monitoring item: you watch it, and if it has not closed by the time of neuter, it is repaired then in the same anaesthetic. The rare and genuinely urgent version is strangulation, where a loop of intestine slips through the opening and its blood supply is pinched off. That is a true emergency — and it announces itself.

A related finding the vet checks for in the same pass is the inguinal hernia, in the groin where the inguinal canal runs — the same canal the testicles travel through. Inguinal hernias occur in both sexes and follow similar logic: small and reducible is monitored and repaired at neuter; a hernia containing bowel that becomes firm or painful is urgent. Both umbilical and inguinal hernias have a heritable component, which is part of why a responsible programme tests against the trait and places pet puppies on non-breeding terms — so it is not propagated.

The heart: innocent murmurs and the ones that are not

Few findings empty the air from an exam room like “I’m hearing a murmur.” A heart murmur is simply the sound of turbulent blood flow, and in a young puppy it is common — by one estimate, around a quarter of puppies under four months have one. The reassuring majority are innocent (also called physiologic): soft, low-grade sounds, with no structural disease behind them, thought to arise partly from the ordinary physiologic anaemia of a fast-growing puppy whose blood volume is outpacing its red-cell count.

Now the essential caveat, the one a careful owner must hold: an innocent murmur and a murmur caused by a congenital heart defect cannot be reliably told apart by ear alone. A soft murmur in a thriving, energetic, normally-growing puppy is reasonably handled with watchful waiting and a recheck. But the only way to confirm the heart is structurally normal is an echocardiogram — an ultrasound of the heart — performed by someone who can see the valves and chambers directly. The grade of a murmur, heard through a stethoscope, does not reliably track the severity of any underlying defect.

One nuance keeps the picture honest: “outgrown by six months” is the textbook line, but it is not a law. A long-running study of Boxer puppies found that some innocent-sounding murmurs persisted into adulthood with structurally normal hearts. The practical upshot is unchanged: a soft murmur in a well puppy is a recheck, and if it does not resolve on schedule — or if anything about it is loud or symptomatic — an echocardiogram settles the question rather than leaving it to be guessed at year after year.

The gut: parasites, and why “just stress” is a trap

Few things rattle a new owner like loose stool in a days-old arrival, and the reflex explanation is always the same: it is the stress of the move. That is half-true in a way that can be a trap. Stress of rehoming genuinely can loosen stools — but the two most common infectious causes of puppy diarrhea, coccidia and giardia, flare precisely when a puppy is stressed. The move does not rule them out; it is the very thing that brings them out.

The reason this matters in practice is that neither parasite responds to the routine broad-spectrum dewormer a puppy gets at its first visits — the medicine aimed at roundworms and hookworms. Coccidia needs its own drug (commonly sulfadimethoxine or off-label ponazuril); giardia needs another (often fenbendazole and/or metronidazole), with a re-test afterward because relapse is common. So the practical rule is simple and worth stating plainly: diarrhea in a young puppy deserves a fecal test and a vet conversation rather than waiting it out. Dehydration arrives fast at this age, and the cycle is far easier to break early than late.

This is also the right place to retire a myth about deworming. A clean fecal sample does not prove a puppy is parasite-free, because shedding is intermittent — which is exactly why reputable breeders deworm on a schedule rather than only on a positive test, and why a puppy may be dewormed several times before going home. Roundworms in particular are so common in puppies, passed from the dam, that scheduled deworming is the standard of care, not a sign anything is wrong. If your puppy’s paperwork shows a deworming schedule and a recently-given parasite preventive, that is the system working as intended — though it is always worth confirming the products are compatible with anything your own vet adds.

The skin: juvenile demodicosis and the look-alikes

A small bald patch — often on the face or a foreleg, a little thin and flaky but not itchy — turns out, on a skin scrape, to be demodex. Owners hear “mites” and brace for something contagious and grim. The reality of the juvenile, localised form is far gentler. Demodex mites live in the hair follicles of virtually all dogs as normal residents, passed from the mother to her pups in the first days of life through skin contact. They cause no trouble at all in the vast majority of dogs. Localised juvenile demodicosis is what happens when a small patch of them briefly outpaces a still-maturing immune system.

The distinction that matters is localised versus generalised. A single patch, or a couple, in a young puppy is the benign, self-limiting picture — monitored, not treated, and watched to confirm it clears. Widespread disease (several sites, whole regions, multiple paws, or a puppy who is itchy and infected) is the generalised form, which does need treatment and a look for any underlying cause. The everyday version, the one most owners actually meet, sits comfortably in the “watch it clear” column. Its main mischief is that it looks like other things — ringworm, puppy impetigo, an allergy — which is exactly why the vet reaches for a skin scrape rather than guessing.

The breed’s own: juvenile epilepsy and what health testing buys

Everything so far could be written for any breed. This section could not. The Lagotto Romagnolo carries a condition that is, as far as the veterinary literature records, essentially unique to it — and it is precisely an early-puppy condition, which makes it the heart of any honest guide to a Lagotto’s first months. It is called benign familial juvenile epilepsy, or BFJE.

What it looks like is frightening, and there is no use pretending otherwise. An affected puppy has episodes of trembling, unsteadiness, stiffness, sometimes whole-body shaking, lasting from seconds to a few minutes; the puppy may or may not seem conscious through it, and it can happen at any time of day. To watch your eight-week-old puppy seize is one of the worst feelings a new owner can have. The word that redeems the picture is benign — and it is earned not by the experience but by the outcome. In the overwhelming majority of cases the seizures stop for good by around four months and the dog goes on to a normal life.

The genetics are now well understood, and they are the reason this condition can be designed out of a breeding programme rather than merely endured. In 2011, Seppälä and Jokinen and colleagues identified the cause: a recessive truncating mutation in the LGI2 gene (c.1552A>T, p.K518X), published in PLoS Genetics. Recessive means a puppy must inherit the mutation from both parents to be affected; a dog with one copy is an unaffected carrier. Roughly half of the breed carries a copy — a legacy of the breed’s near-extinction and tight genetic bottleneck in the 1970s. Italian breed-health sources describe the same picture in the breed’s home country: an epilessia giovanile appearing at 5–9 weeks and regressing by 8–13 weeks.

The arithmetic is the whole argument for testing. Breed two carriers and, on average, one puppy in four is affected. Test the parents first — a simple cheek swab or blood draw — and you can pair a carrier only with a clear dog, which produces no affected puppies at all while still using a worthy dog for breeding. This is not exotic; it is the routine discipline of a responsible Lagotto programme, and it is why a buyer should always ask to see the parents’ DNA results. The mutation is known, the test is cheap, and the disease is therefore entirely avoidable in a planned litter.

One important honesty: “benign” describes the typical course, not a guarantee. A small number of dogs have shown a rare later seizure, and in very rare cases a Lagotto with a related picture has a progressive neurological course rather than the classic remitting one. That is why any seizing puppy — Lagotto or not — should be seen by a vet to confirm what is actually happening rather than assuming the benign script. Confirmation, not assumption, is the rule.

The other genetic name you will hear: storage disease

A buyer researching Lagotto health quickly meets a second condition commonly called Lagotto storage disease — more precisely, an autophagy-related neurodegenerative storage disease — caused by a different recessive mutation, in the ATG4D gene (c.1288G>A), identified by Kyöstilä and colleagues in 2015. It is worth understanding precisely because it is not usually an early-puppy finding: its signs — a progressive wobbliness or cerebellar ataxia, sometimes flicking eye movements and behavioural change — typically appear anywhere from four months to four years, averaging around two years. It belongs in this essay not as a thing to look for in a twelve-week-old, but as the clearest possible illustration of why the parents’ testing matters more than the puppy’s exam. Some inherited conditions cannot be seen on a healthy puppy at all; the only place to catch them is in the breeding decision that produced the litter.

Why so many of these are inherited — and what that means

Read back over the findings and a thread runs through them. Cryptorchidism is heritable. Umbilical and inguinal hernias have a heritable component. Jaw-length malocclusion is considered genetic. Hip dysplasia is polygenic. BFJE and storage disease are single-gene recessive conditions. A reasonable owner might find this alarming — so much of it inherited — but the right reading is the opposite. Inheritance is what makes these conditions addressable. A trait that runs in families is a trait a thoughtful breeder can select against, and a trait a buyer can ask intelligent questions about.

This is where the Italian framework that built the breed shows its value. The Fondazione Salute Animale, accredited by ENCI — the Italian national canine body — certifies breeding dogs not only for hip and elbow dysplasia but for hereditary eye disease, hereditary heart disease, congenital deafness, and patellar luxation. Hip dysplasia, the Italian sources note, is polygenic and shaped by environment as well as genes, can be transmitted by a parent who shows no signs themselves, and is formally scored on radiographs from twelve months of age. None of that can be read off a twelve-week-old puppy — which is the entire point of testing the parents.

So the practical meaning of “most of these are inherited” is not fatalism. It is a to-do list with two columns. The breeder’s column: test the parents rigorously, pair carriers only with clear dogs so no affected puppy is ever produced, place every puppy on limited registration by default, and disclose everything. The owner’s column: ask to see the results, understand what a limited-registration, spay/neuter contract is actually protecting against, and treat the parents’ health records as more informative than any single finding on your puppy’s first exam. A finding on the puppy is a snapshot; the parents’ testing is the whole film.

That is also why, at Northwest Lagotto, every puppy goes home on limited registration as a matter of course — not as a verdict on any one dog, but as the default of a disciplined programme. Full breeding rights are a separate, deliberate path: offered only to owners who want them, only once that individual dog’s own health testing is complete after two years of age, and on agreed terms. The result of testing the parents this rigorously is the record we are proudest of — we have never produced an affected puppy.

When it actually is an emergency

This guide has spent most of its length arguing for calm, which makes it doubly important to be clear about the small set of situations that are not calm at all. The far-right column of the spectrum is thinly populated, but it is real, and a good owner knows it cold. None of these is a “wait for the recheck” situation; each is a same-day or right-now call.

• A hernia that turns firm, painful, hot, or suddenly larger, especially with vomiting or lethargy — possible strangulation of trapped bowel. This is surgical and urgent.
• A puppy that is seizing for the first time, or seizing repeatedly — even in a Lagotto where BFJE is likely, the first episode should be seen, both to confirm the benign diagnosis and to rule out the rare serious mimics.
• Diarrhea or vomiting with collapse, refusal to drink, or a puppy going limp and cold — dehydration and hypoglycaemia (a dangerous drop in blood sugar, to which small young puppies are prone) can move from worrying to life-threatening within hours.
• Laboured breathing, blue or grey gums, or sudden collapse — whatever the cause, these are never to be watched.
• A known congenital murmur with new coughing, breathlessness, or exercise intolerance — the small minority of murmurs that signal real heart disease declaring itself.

The clean mental model is the one we started with. The two middle columns — watch, and plan a routine fix — hold the great majority of what a puppy’s first months will throw at you, and they run on the calendar: recheck at the deciding age, fix at neuter if needed. The far-right column runs on the clock: it is happening now and it needs help now. Knowing which calendar a finding belongs on is most of the wisdom.

To put that into practice, the tool below walks the same logic you would: it asks the two questions — is harm happening now, and has the deciding age passed — and points you toward watch, plan, or call. It is a thinking aid, not a diagnosis, and it never replaces the exam in front of your actual puppy.

A field guide is not a verdict

The exchange that prompted this essay was an email from a thoughtful new owner whose vet had found two things on her puppy’s first exam — a bite to monitor and a testicle not yet down. She was not panicking; she was doing exactly the right thing, which was asking good questions of people who had seen it before. Her instinct, and her vet’s, was the correct one: watch, with a clear idea of the ages that would eventually decide. Nothing about the answer required alarm. It required a map.

That is what this has tried to be. The first months of a puppy’s life will hand you findings — it is the nature of watching a body get built by a professional whose job is to notice. The skill is not memorising every condition. It is holding the two questions steady when the room narrows: is harm happening now, and has the deciding age passed? Answer those honestly, finding by finding, and the great majority of what you meet resolves into “watch” or “plan a routine fix” — with a small, important set that means “call now,” which you will recognise because you read this before you needed it.

And if your puppy came from us, you will not meet most of this as a surprise. We disclose every finding we have seen before you drive home; our parent testing is disciplined enough that we have never produced an affected puppy; every puppy goes home on limited registration by design; and we are at the other end of the phone for the whole of that first year and well beyond it. A field guide is a fine thing to have in your hand. A breeder who already knows your puppy is a better one.

Common questions

Keep reading

This guide sits among a set of related Journal essays. If you came for one finding, these go deeper on the threads it touched.