A) Primary needs
1) Warmth
Kittens have virtually no body fat and do not shiver until they are about 3
weeks of age. Therefore, they must and rely on an external heat source, ideally
the dam, for maintenance of normal body temperature. Orphans should be maintained
in an environment at about 85oF (29.5oC) for the first two weeks of life, and
about 80oF (26.5oC) for the subsequent two weeks. Warmed and cooler areas should
be available, so the kittens can crawl to an area appropriate in temperature.
Among surface sources of heat, circulating hot water blankets are best. Hot
water bottles should be wrapped in towels and frequently changed. Regular heating
pads may heat unevenly and more easily burn the fragile skin of neonates. Heat
lamps are an excellent, safe way to provide radiant heat.
2) Hydration
Assess for hydration by (i) tackiness of mucous membranes - be aware that if
there's milk in their mouth, their gums will feel slippery, (ii) color of urine
- normal urine in neonates is clear so if it looks at all yellow, they're dehydrated,
(iii) skin tenting? - less valuable because of lack of subcutaneous fat.
Fluids should be warmed before administration. Fluids can be given subcutaneously
but will be taken up very slowly by that route. Intraosseous administration
of fluids may be necessary in severely dehydrated, recumbent animals.
3) Nutrition
a) Type of diet
Milk is the primary diet of kittens up to three weeks of age. Do not feed milk-based
products to animals with a body temperature less than 96 oF. At this low body
temperature, ileus (lack of intestinal motility) permits souring of milk in
the stomach rather than normal movement of milk into the small intestines. Chilled
animals may be provided nutrition with a commercial veterinary nutritional product,
such as Neutrical, rubbed on the gums and can be provided oral fluid and electrolytes
with a commercial human product, such as Pedialyte.
Milk, composed of about 85% water, is the primary source of fluid for neonates
and is vital for maintenance of normal hydration and fluid volume and provision
of non-nutritive bioactive agents, such as enzymes, hormones and growth factors.
An effort should always be made to find a lactating queen to support orphan
animals. No commercial or homemade milk replacer contains all the components
of bitch's or queen's milk. Goat's milk, a commonly described supplement for
orphans, is a poor substitute for queen's milk. Feline milk replacers must contain
a source of taurine for optimal growth to occur. Problems reported with feeding
of either commercial or home-made milk replacers to puppies and kittens include
small, focal cataracts due to deficiencies in vitamins or amino acids that resolve
after weaning, and slower growth rate due to lack of enzymes necessary for fat
digestion. Hand-raised kittens achieve the same size as littermates allowed
to nurse by several months of age. The decreased caloric density of formulas
makes it difficult to provide orphans with an adequate number of calories without
inducing diarrhea. If feeding induces diarrhea, the formula can be diluted 1:2
with electrolyte solution until the neonate can tolerate it.
b) Amount to be fed
Amount to be fed varies with caloric density of the formula, and age and weight
of the animal. Kittens should receive 100-175 kcal per pound (220-380 kcal/kg)
daily, split into 4-6 feedings. Feeding frequency can be decreased to 3 times
daily after the orphan reaches 2 weeks of age. Consider, for example, a diet
that contains 237 kcal/cup, which equals 30 kcal/fl oz (3 kcal/ml). Kittens
require 100-175 kcal/pound daily; a 4 oz (1/4 pound = 113 gm) kitten requires
25-44 kcal daily. The amount to be fed daily is 0.8 - 1.5 fl oz (8-15 ml). This
yields, for 4 daily feedings, a per feeding volume of 0.2 - 0.4 oz (2-4 ml).
Commercial milk replacers often bypass discussion of calories, providing volume
instructions only. An example is the kitten milk replacer, KMR (Pet-Ag, Elgin
IL; 2 T / 4 oz (10 ml / 125 gm) daily). If volume is used to determine amount
to be fed, regular weighing of the kitten is essential.
The kitten should have been weighed at birth, and should be weighed daily thereafter.
Kittens should weigh about 3.5 oz (100 gm) at birth. Slight weight loss may
occur in the first 24 hours of life. After that, the kitten should gain weight
daily, doubling their birth weight by 7-10 days of age. Kittens should gain
1.8 - 3.5 oz (50-100 gm) weekly.
c) Feeding technique
The formula should be warmed to 95-100oF (35-38oC) when feeding 1-2 week old
animals. Equipment for feeding of pediatric animals includes spoons, droppers,
bottles, or tubes. Spoon- and dropper-feeding are dangerous since the limited
gag reflex of puppies and kittens easily permits aspiration of formula into
the lungs.
Bottle-feeding poses less risk of aspiration and more readily satisfies the
neonate's need to suckle. Small bottles marketed for animals or bottles intended
for premature human infants may be used. The hole in the nipple should allow
milk to ooze slowly. The bottle should never be squeezed to force expulsion
of milk while the animal is nursing. Place the kitten on its ventrum in your
hand or on a surface to which it can cling, such as a towel. Open its mouth
gently and insert the nipple. Hold the bottle upward at about a 45 degree angle;
gentle pulling on the bottle to keep the nipple taut in the animal's mouth promotes
vigorous suckling.
Tube-feeding is quick. Caution must be used to ensure proper placement of the
tube into the gastrointestinal tract and to prevent overflowing and regurgitation.
The feeding tube varies in diameter and length with age. A #5 French feeding
tube should be used in animals weighing less than 300 gm and a #8-10 French
feeding tube used in animals weighing more than 300 gm. Measure the length of
the feeding tube by marking off 75% of the distance from the animal's last rib
to the tip of its nose. This length ensures placement in the stomach without
kinking of the tube within the gastrointestinal tract. Length should be rechecked
and adjusted weekly. The animal should be held horizontally on its ventrum.
Advance the tube over the tongue. If the kitten cries once the tube is placed,
you know you're not in the trachea. The warmed formula is gently expelled through
the tube with a syringe. If milk bubbles through the nostrils, stop immediately
and check placement of the tube. Monitor gastric distension; average stomach
capacity in neonates is about 0.7 fl oz (4 tsp) per pound (40 ml/kg).
d) What about colostrum?
Ascertain, if possible, whether the kitten has ingested colostrum. More than
90% of maternal antibodies are passed to the neonate via the colostrum. Neonates
should be encouraged to begin nursing within 2-3 hours of birth. Maximal absorption
of antibodies through the intestine occurs at 8 hours after birth, and decreases
significantly by one day of life. Serum IgG concentrations are low at birth,
increase rapidly to a peak 18 hours after ingestion of colostrum, and then decline
to a nadir at 3-4 weeks of age. If a kitten has not ingested colostrum, antibodies
can be provided by subcutaneous administration of serum from the dam or another
immunocompetent animal in the household. In a study of 43 kittens, comparing
subcutaneous administration of antibody-rich serum to suckling, it was demonstrated
that both techniques significantly increased protective antibody concentrations
in kittens, compared to a control group that received no antibodies. The empirical
dose is 15 ml of serum, given subcutaneously as 5 ml boluses at birth and 12
and 24 hours later. Finally, be aware that composition of milk in queens does
not vary over the lactation, such that queens late in lactation still contain
large amount of antibody in their milk and could provide passive immunity for
kittens within the first 24 hours of life. Early vaccination may be warranted
in kittens that did not receive adequate amounts of colostrum.
e) Weaning
Weaning, introduction of solid food, begins at 3-4 weeks of age in kittens.
Young animals need more nutrients to allow for normal growth and development
but take longer to ingest food and have a smaller digestive capacity, necessitating
feeding of an energy dense, highly digestible food. Food should be offered as
a gruel initially, formed by thoroughly blending 1 part dry food to 3 parts
formula or 2 parts canned food to 1 part formula for kittens. Fewer problems
with post-prandial gastric distension occur if the food is thoroughly soaked.
Fresh water always should be provided as well. Gradually mix less water or formula
with the food until the kitten is eating dry food exclusively. Weaning usually
is complete by 6-8 weeks of age. By the time the animal is weaned, it should
have a body weight roughly 6-10 times its birth weight.
4) Elimination
Gently massage the genitalia with a cotton ball or soft washcloth after every
feeding, to stimulate urination and defecation. Normal kitten feces often are
mustard yellow in color and pasty.
Constipation is considered to be present if the animal has not defecated in
over a day or if very firm stool is palpable in the colon. A gentle enema with
warm water containing just a tiny bit of dishwashing liquid, using a red rubber
tube, may be performed to help break up firm stool and encourage passage. If
recurrent constipation occurs, the milk replacer should be diluted. Some individuals
report success with feeding kittens small amounts of plain yogurt as well; this
can be spooned into their mouth or diluted with water and passed through a feeding
tube.
5) Handling
It has been demonstrated that kittens that are regularly handled are tamer and
more readily adopted after weaning. After stimulation of urination and defecation,
rub the kitten with a warm, slightly rough towel. This simulates grooming by
the mother. It also helps keep the kitten clean and makes you aware of any disease
conditions, such as suckling injury from neonates or fleas.
B) Landmarks
Eyelids open at about 7-10 days of age - The eyes may appear cloudy when first
open due to corneal edema; this should clear within 1-2 days. Eye color will
change with age, stabilizing by about 3 months of age.
Ear canals open and pinnae become erect at about 2-3 weeks of age.
Kittens will first attempt to stand at about 2-3 weeks of age and should be
mobile by 3-4 weeks of age.
Teeth first emerge at 3-4 weeks of age.
C) Common problems
1) Diarrhea - Diarrhea often occurs secondary to overfeeding of neonates or
disruption of the normal gastrointestinal environment with changes in diet or
antimicrobial therapy. Primary bacterial diarrhea also has been reported. Treatment
is supportive care with fluid therapy and assessment of the feeding schedule.
Intestinal parasites are common in young animals, especially those born in warm
climates or in closely managed facilities. In kittens, roundworms (Toxocara
canis) are very common. Roundworms can pass transplacentally in late gestation.
Within infected kittens, the larvae may migrate to the lungs and liver, causing
a non-productive cough and poor weight gain. Treatment of kittens 2 weeks of
age or older is with pyrantel pamoate (5-10 mg/kg per os once daily for 2-3
weeks). Use of piperazine is not recommended in kittens. Coccidiosis can occur
in kittens. Infection usually is asymptomatic and self-limiting. If diarrhea
occurs, treatment may be instituted with sulfadimethoxine (30 mg/kg once daily
in kittens weighing at least 1 kg) until signs regress. Similarly, infection
with Giardia sp. usually is asymptomatic and self-limiting. If necessary, kittens
can be treated with either metronidazole (30 mg/kg per os once daily for 7-10
days or 25 mg/kg per os twice daily for 5 days, then 10 mg/kg twice daily) or
fenbendazole (50 mg/kg per os once daily for 3-7 days). Pentatrichomonas hominis
is a trichomonad parasite, reported to cause diarrhea in some affected kittens.
2) Upper respiratory infections - A complex of respiratory diseases occurs in cats caused by viruses, such as rhinotracheitis and calicivirus, bacteria including Bordetella bronchiseptica and Chlamydia psittaci and, rarely, fungal organisms. Queens often are asymptomatic until stressed by queening, at which time organisms are shed and the less immunocompetent kittens infected. Clinical signs vary from mild conjunctivitis and serous oculonasal discharge to sneezing, tenacious oculonasal discharge, self-trauma due to pawing at the face, and respiratory distress. The condition usually is self-limiting and resolves in 10-14 days. Antibiotic therapy may hasten resolution of clinical signs. Nursing measures include frequent cleaning of the face with warm water and increased humidification of air in the environment; be cautious with the latter as some kittens cannot tolerate very humid air and will become dyspnic. Calicivirus infection also may be associated with mononuclear cell infiltration of joints, causing a lameness that usually is self-resolving; this is sometimes termed "limping kitten syndrome."
3) Fleas - Fleas are a common external parasite of young animals. Severe flea
infestation can cause anemia, with clinical signs including pale mucous membranes,
lethargy, tachycardia, and collapse and death. Fleas also can transmit tapeworms.
The preferred treatment for fleas in animals less than 2 months of age is thorough
bathing and grooming with a flea comb. Dipping and/or systemic treatment is
not recommended for animals less than 3 months of age.
4) Septicemia - Septicemia is system-wide infection with one or more bacterial
organisms. Entry occurs most commonly via the umbilicus. The animal may be predisposed
to septicemia by inadequate ingestion of colostrum or concurrent disease of
the neonate or dam. Gram-negative organisms are most commonly involved, with
E. coli the most prevalent isolate. Clinical signs vary with the organ(s) affected.
Reported syndromes include gastroenteritis with foamy vomitus, liquid diarrhea,
reddening of the anus, rapid dehydration and death, pyelonephritis with abdominal
pain, fever, dehydration and hematuria, omphalitis, conjunctivitis, pneumonia
with respiratory distress and cyanosis, and non-specific weakness, vocalization
and dehydration. Acute respiratory distress syndrome, characterized by life-threatening
non-cardiogenic pulmonary edema, may occur secondary to septicemia, as may sloughing
of the extremities, perhaps due to concurrent disseminated intravascular coagulation
(DIC), tissue hypoxemia or vasculitis. Putative diagnosis is based on clinical
signs, presence of normocytic normochromic anemia, thrombocytopenia, and mild
to moderate neutrophilia with a left shift on complete blood count, and hypoglycemia
on serum chemistry profile. Definitive diagnosis requires blood culture. Urine
culture may be positive in some septicemic animals. Septicemia is commonly diagnosed
at necropsy. Treatment of septicemia requires fluid therapy to counter dehydration
and hypoglycemia (balanced electrolyte solution with 5% dextrose and KCl supplement
if serum potassium concentrations are less than 2.5 mEq/L), oxygen therapy for
management of tissue hypoxemia, and appropriate antibiotic therapy. Penicillins
and cephalosporins are appropriate empirical choices pending culture and sensitivity
results.