PawsureGuide

Common Health Issues in Small Dog Breeds (and Insurance Tips)

PawsureGuide Team ·

There’s a persistent myth among dog owners that small dogs are healthier than big dogs. After all, they live longer — a Chihuahua can easily reach 15-17 years, while a Great Dane is lucky to hit 8. Longer lifespan must mean better health, right?

Not exactly. Small dogs live longer, but they’re not exempt from health problems. In fact, many small breeds come with a very specific set of health issues that can be just as expensive to treat as the big-breed conditions like hip dysplasia and bloat. Luxating patellas, dental disease, collapsed trachea, and heart murmurs are all over-represented in small breeds, and the vet bills add up faster than most owners expect.

Let’s go through the most common health issues affecting small dog breeds, which breeds are most at risk, what treatment costs, and how to make smart insurance decisions for your little dog.

1. Luxating Patella (Slipping Kneecap)

What It Is

Luxating patella is a condition where the kneecap (patella) slides out of its normal position. You might notice your small dog suddenly skip a step, hold one back leg up while running, or “kick out” their leg to pop the kneecap back into place. It ranges from mild (Grade 1, occasional luxation) to severe (Grade 4, permanent displacement).

Which Small Breeds Are Affected

This is overwhelmingly a small-dog problem. The breeds most commonly affected include:

  • Pomeranian — one of the highest incidence rates of any breed
  • Yorkshire Terrier — very common, often bilateral (both knees)
  • Chihuahua — high predisposition, especially in teacup-sized dogs
  • Maltese — frequently diagnosed, often by age 2-3
  • Toy and Miniature Poodle — genetic predisposition
  • Boston Terrier — moderate to high incidence
  • French Bulldog — combined with their other joint issues

Check if your breed is at risk on our small breed category page.

Treatment Costs

  • Grade 1-2 (mild): Conservative management with joint supplements, weight management, and occasional anti-inflammatory medication — $200-$500/year
  • Grade 3-4 (severe): Surgical correction — $1,500-$4,000 per knee. Many dogs need both knees done, so double that.

Insurance Considerations

Luxating patella is considered hereditary/congenital by most insurance providers. Make sure your plan covers hereditary conditions. Also, watch out for bilateral condition clauses — some providers may exclude the second knee if the first was affected before enrollment. And be aware of orthopedic waiting periods: some providers have a 6-month wait specifically for orthopedic issues, meaning any symptoms during that window could be classified as pre-existing.

2. Dental Disease

What It Is

Dental disease is the most widespread health problem in small dogs, bar none. By age 3, over 80% of dogs show some degree of periodontal disease, but small breeds are hit much harder and much earlier than larger dogs. Their small jaws create crowded teeth, trapping food and bacteria. The result is accelerated tartar buildup, gum inflammation, tooth decay, and eventually tooth loss.

Left untreated, dental disease doesn’t just affect the mouth. Bacteria from infected gums can enter the bloodstream and damage the heart, kidneys, and liver. Dental disease literally shortens your small dog’s life.

Which Small Breeds Are Affected

Virtually all small breeds are prone, but these are the worst:

  • Chihuahua — notoriously bad dental health, often needing multiple extractions by age 5
  • Yorkshire Terrier — one of the highest rates of dental disease
  • Dachshund — elongated jaws don’t help; dental issues are very common
  • Cavalier King Charles Spaniel — dental problems compounded by heart disease risk
  • Shih Tzu — crowded teeth due to flat face structure
  • Pomeranian — small jaw, tiny teeth, big dental problems
  • Italian Greyhound — thin jawbones make dental disease more dangerous

Treatment Costs

  • Annual dental cleaning under anesthesia: $300-$800
  • Dental cleaning with extractions: $800-$2,500 (depending on how many teeth need to come out)
  • Advanced dental surgery (jaw fracture repair from severe decay): $2,000-$5,000

Most small dogs will need at least one professional dental cleaning per year, and many will need extractions at some point. Over a 12-15 year lifespan, dental costs alone can exceed $10,000.

Insurance Considerations

Here’s the frustrating part: most standard pet insurance plans do NOT cover routine dental cleanings. Dental cleaning is considered preventive care and requires a wellness add-on. However, dental disease that requires treatment (extractions, surgery) is typically covered under accident-and-illness plans, as long as it’s not classified as a pre-existing condition.

If you have a dental-prone small breed, a wellness add-on that covers dental cleanings ($15-$30/month) can be worth it. Providers like Embrace and Pets Best offer solid wellness options for dental coverage.

3. Collapsed Trachea

What It Is

The trachea (windpipe) is held open by C-shaped cartilage rings. In some small dogs, these rings weaken and flatten over time, causing the trachea to collapse partially or fully. The signature symptom is a harsh, honking cough, especially during excitement, exercise, or when pulling on a leash. Severe cases can cause breathing distress and cyanosis (blue-tinged gums).

Which Small Breeds Are Affected

  • Yorkshire Terrier — the breed most commonly associated with collapsed trachea
  • Pomeranian — very high incidence
  • Chihuahua — frequently affected
  • Toy Poodle — moderate to high risk
  • Shih Tzu — moderately common
  • Maltese — occasionally affected

Treatment Costs

  • Mild cases (managed with cough suppressants, weight management, harness instead of collar): $200-$600/year
  • Moderate cases (anti-inflammatory drugs, bronchodilators): $500-$1,500/year
  • Severe cases (tracheal stent placement surgery): $3,500-$6,500

Tracheal stent surgery has improved dramatically in recent years and can give severely affected dogs years of comfortable breathing. But it’s expensive and not without risks.

Insurance Considerations

Collapsed trachea is typically covered by accident-and-illness plans because it’s a medical condition, not a preventive issue. However, if your dog showed any coughing symptoms before enrollment, the condition could be flagged as pre-existing. Enroll early, before symptoms develop.

4. Hypoglycemia (Low Blood Sugar)

What It Is

Hypoglycemia is a dangerous drop in blood sugar that can cause weakness, trembling, seizures, and in severe cases, coma or death. It’s particularly common in very small breed puppies (under 5 pounds) and in adult toy breeds that skip meals.

Toy breed puppies have high metabolic rates relative to their tiny body mass, and they can’t store much glucose. A missed meal, stressful event, or cold environment can trigger a hypoglycemic episode quickly.

Which Small Breeds Are Affected

  • Chihuahua — especially teacup-sized individuals
  • Yorkshire Terrier — puppies are particularly vulnerable
  • Maltese — common in puppies and small adults
  • Pomeranian — toy-sized individuals at higher risk
  • Toy Poodle — occasionally affected

Treatment Costs

  • Mild episode (home management with sugar water/honey): $0
  • Moderate episode (vet visit, IV glucose): $200-$500
  • Severe episode (emergency hospitalization, monitoring): $800-$2,000
  • Recurring episodes requiring diagnostic workup: $500-$1,500

Insurance Considerations

Hypoglycemic episodes requiring veterinary treatment are covered under accident-and-illness plans. If your puppy has a known history of hypoglycemia before enrollment, subsequent episodes may be excluded. Get insurance as early as possible — many providers allow enrollment at 8 weeks.

5. Intervertebral Disc Disease (IVDD)

What It Is

IVDD occurs when the cushioning discs between the vertebrae of the spine bulge or rupture, pressing on the spinal cord. It can cause pain, weakness, difficulty walking, and in severe cases, paralysis. While it’s often associated with Dachshunds, several small breeds are affected.

Which Small Breeds Are Affected

  • Dachshund — the poster child for IVDD; 1 in 4 Dachshunds will experience it
  • French Bulldog — very high incidence due to body structure
  • Pekingese — long back, short legs, high risk
  • Beagle — moderate risk
  • Cocker Spaniel — moderate risk
  • Shih Tzu — moderate risk

Treatment Costs

  • Conservative treatment (rest, anti-inflammatories, pain medication): $500-$2,000
  • Surgical intervention (hemilaminectomy): $3,000-$8,000
  • Rehabilitation and physical therapy: $1,000-$3,000 over weeks/months
  • Wheelchairs for paralyzed dogs: $200-$500

A single IVDD episode requiring surgery can cost $5,000-$10,000 when you factor in diagnostics (MRI alone is $2,000-$3,000), surgery, hospitalization, and rehab.

Visit our French Bulldog insurance guide for a deep dive on IVDD costs for Frenchies specifically.

Insurance Considerations

IVDD is covered by all standard accident-and-illness plans that include hereditary conditions. Given the high cost of surgery, make sure your annual coverage limit is at least $10,000 — preferably unlimited. And since IVDD can recur at different spinal locations, per-incident deductibles can actually work in your favor here (you pay a new deductible, but each new disc is treated as a separate condition).

6. Heart Disease (Mitral Valve Disease)

What It Is

Mitral valve disease (MVD) is a progressive heart condition where the mitral valve deteriorates, causing blood to leak backward in the heart. Over time, this leads to heart enlargement, fluid buildup in the lungs, and eventually heart failure. It’s the most common heart disease in dogs and disproportionately affects small breeds.

Which Small Breeds Are Affected

  • Cavalier King Charles Spaniel — virtually 100% incidence by age 10; the most severely affected breed
  • Dachshund — high incidence in older dogs
  • Miniature and Toy Poodle — commonly affected
  • Chihuahua — moderate to high risk
  • Maltese — moderate risk
  • Shih Tzu — moderate risk

Treatment Costs

  • Diagnosis (echocardiogram, X-rays): $500-$1,500
  • Ongoing medication (pimobendan, ACE inhibitors, diuretics): $100-$300/month
  • Emergency treatment for congestive heart failure: $1,500-$4,000
  • Ongoing monitoring (quarterly vet visits, echocardiograms): $500-$1,000/year

Over a 3-5 year management period, total costs for MVD can reach $10,000-$20,000. This is a chronic, progressive condition — not a one-time expense.

Insurance Considerations

MVD is where pet insurance provides its clearest value proposition for small breeds. A per-incident deductible (like Trupanion’s) means you pay the deductible once for MVD and then all related treatments for life are covered. With an annual deductible, you’re covered each year but reset the deductible in January. Either way, insurance covering $100-$300/month in medications alone makes the math work overwhelmingly in your favor.

Insurance Strategy for Small Dog Breeds

Now that you know what you’re up against, here’s how to build a smart insurance strategy for your small dog:

Get Insurance Early

Most small breed health issues are either hereditary or develop over time. Enrolling at 8-12 weeks means nothing is pre-existing. Every month you wait is another month for a symptom to appear and become an exclusion.

Prioritize Hereditary Coverage

This is non-negotiable for small breeds. Luxating patella, IVDD, MVD, and collapsed trachea are all hereditary conditions. If your plan doesn’t cover hereditary conditions, it’s essentially useless for the issues your small dog is most likely to face.

Consider a Wellness Add-On for Dental Coverage

Small breeds need regular dental care. A wellness plan that covers annual dental cleanings saves $300-$800/year and prevents the costly extractions that come from neglected dental health.

Match Your Coverage to Your Breed’s Risks

  • Cavalier King Charles Spaniel: Maximum coverage with low deductible — MVD alone can cost $15,000+
  • Dachshund: High annual limit or unlimited coverage — IVDD surgery is $5,000-$10,000
  • Chihuahua: Moderate coverage with dental wellness add-on — their biggest costs are dental and luxating patella
  • Yorkshire Terrier: Comprehensive coverage — they’re at risk for collapsed trachea, dental disease, AND luxating patella
  • Pomeranian: Similar to Yorkies — multiple concurrent health risks

Look up your specific breed’s risk profile on our breed pages to see exactly which conditions to plan for. And if you’re still figuring out what coverage level is right, our insurance quiz can match you with a recommendation based on your breed, age, and budget.

The Bottom Line

Small dogs may live longer, but they’re not cheaper to care for. Between dental cleanings, luxating patella surgery, tracheal management, and potential heart disease, a small breed can easily accumulate $15,000-$30,000 in lifetime veterinary costs for breed-related conditions alone.

Pet insurance flips those numbers in your favor — but only if you get the right coverage, early enough, from a provider that covers hereditary conditions without restrictive waiting periods.

Your little dog is counting on you to think ahead. The vet bills will come; it’s just a question of whether you’ll be financially ready when they do.