Breed · Shih Tzu

Shih Tzu Health, Life Stage by Life Stage

Shih Tzus live long and well when three things get the attention they deserve: airway, eyes, and teeth. A CVT's guide to breed-specific care and the interventions that compound.

Rachel Howland, CVT (ret.)

Updated Apr 24, 2026 · 8 min read · Edited for Veta

Shih Tzus were consistently the friendliest patients on our schedule at the Albany practice. They came in with kidneys working, teeth failing, and eyes that needed somebody paying attention. The breed isn't medically complicated. The complication is that three distinct surveillance areas all need to run simultaneously for the dog to stay well, and none of them is the dramatic emergency that forces a conversation. Shih Tzu care is about consistency, not intensity.

If you own a Shih Tzu, here's the health timeline. I built it from the Merck Veterinary Manual breed entries, the AVMA's dental and brachycephalic health position statements, Cornell's ophthalmology publications, and years of working around this breed in mixed practice. The framework is straightforward. Most of what goes wrong traces back to things that could have been caught six months earlier.

Where this breed comes from, and what that means

Shih Tzus were developed in the Tibetan highlands and refined in Chinese imperial courts as companion dogs, with records going back roughly a thousand years. The breed's shortened face and long hair reflect selective breeding for companion rather than working traits. The health profile reflects that history. The small skull, full dental count, and exposed eye structure each map to specific ongoing care.

Lifespan runs 10-18 years, one of the longest ranges in any common breed. Adult weight sits between 4 and 7 kilograms, roughly 9 to 15 pounds. Energy level is low to moderate, and thirty minutes of daily activity is adequate. The breed is famously companion-oriented, which means Shih Tzus do poorly as outdoor dogs and well as indoor family members.

Puppyhood (0 to 12 months)

Puppy visits cover standard vaccines and basic exam. Breed-specific additions: careful evaluation of the airway at each visit, ophthalmology referral for any eye abnormality, and early establishment of dental care routine. The dental brushing habit starts at puppy age. Most Shih Tzus will never enjoy it, but they'll tolerate it if it's introduced early and gently.

The puppy eye exam matters in this breed. Congenital eyelid conditions, including entropion where the eyelid rolls inward, can cause chronic corneal damage if not identified young. A baseline ophthalmology exam through a veterinary ophthalmologist between twelve weeks and six months documents the starting state.

Growth plates in Shih Tzus close around nine to twelve months, and the breed's small size means the exercise calibration is about variety rather than distance. Multiple short walks, controlled play, and puppy socialization build the foundation. No jumping off high furniture, and no climbing steep stairs for the first year.

Young adult (1 to 4 years)

The one-year wellness establishes baseline bloodwork. CBC, chemistry, T4, and urinalysis are the starting set. Airway evaluation continues every visit. A formal BOAS assessment through a veterinary BOAS specialist is worth considering at age two or three if the dog shows any snoring, exercise intolerance, or loud breathing at rest. Mild cases are managed conservatively; moderate to severe cases benefit from surgical widening of the airway, and the procedure is performed more successfully when done before secondary airway damage accumulates.

Dental work typically shifts from baseline to intervention in this window. The first professional cleaning under anesthesia usually falls between ages two and four. Home brushing continues two or three times a week. Your DVM sets the specific cadence for professional cleanings based on the dog's tartar accumulation rate.

Eye surveillance continues annually. Any squinting, redness, excessive tearing, or pawing at the eye is same-day evaluation rather than wait-and-see. The cornea in this breed has less protection than in longer-muzzled dogs, and ulcers can progress from mild to sight-threatening within forty-eight hours.

Mature (4 to 8 years)

Most of this window is stable if the three surveillance areas, airway, eyes, and dental, are being managed. What starts being worth discussing is orthopedic issues. Luxating patella, where the kneecap slips out of position, is common in small breeds and often presents as a skipping gait or brief lameness. X-rays evaluate severity, and surgical correction is appropriate for higher-grade luxations.

IVDD, the cartilage-disc condition that dachshunds are famous for, also appears in Shih Tzus though at lower rates. Any sudden yelping, reluctance to jump up, or hunched back is an emergency visit. The chondrodystrophic spine in this breed can rupture discs with less provocation than a mesomorphic dog would need, and the emergency window for neurologic outcome is the same twelve to twenty-four hours that dachshunds face.

Body-condition scoring at every visit. An overweight Shih Tzu puts more load on an already-short back and on knees prone to patellar luxation. Weight management is usually about portion control and treat reduction rather than major diet overhaul.

Senior (8 and up)

At nine or ten, wellness moves to every six months. Full senior workup covers CBC, full chemistry, T4, urinalysis, blood pressure, and cardiac auscultation. Any new cough warrants chest imaging and airway re-evaluation. Dental work at this age is often about extractions; deferred dental years catch up here. A Shih Tzu undergoing anesthesia for dental at twelve gets a preoperative chemistry panel and often a cardiac workup first. The monitoring during anesthesia, continuous blood pressure, ECG, temperature, matters more in a senior small dog than many owners realize.

Eye work in seniors is often managing chronic dry eye, recurring corneal abrasions, and age-related cataracts. Any visible change in the eye warrants ophthalmology referral. For dogs with significant vision loss, consistent home environment matters; don't rearrange furniture with a vision- impaired senior in the house. Dogs adapt well to reduced vision when their environment is stable.

Kidney function deserves senior attention. The breed shows moderate rates of chronic kidney disease in older dogs, and trending creatinine and SDMA values catches early disease. IRIS, the International Renal Interest Society, publishes the staging scale that guides intervention decisions.

Breed-aware screening for Shih Tzus

Five screens worth knowing about. Annual airway evaluation at every wellness visit, with formal BOAS grading in year two or three if any signs present. Annual eye exams through a veterinary ophthalmologist from puppy age forward. Annual dental evaluation, with professional cleanings as indicated. Orthopedic exam including patellar stability testing at every wellness visit. Routine wellness labs annually from age one, twice yearly from age nine or ten.

Genetic testing for Shih Tzu-specific conditions is available through commercial panels. The clinical utility is in screening for recessive disease carriers, including renal dysplasia and some progressive retinal atrophy variants. A 2023 JAVMA review of consumer genetic testing put the panel output in the useful column for brachycephalic breeds specifically.

Questions worth asking at each stage

Puppy: have we evaluated the eyelids for entropion, is our dental routine in place, and what's our airway baseline. Young adult: do we need formal BOAS assessment, when's our first dental, and is our eye exam annual. Mature: have we checked patellar stability, what's our threshold for imaging back pain, and is weight trending stable. Senior: how often from here, what's our anesthesia protocol for senior dental, and how are we monitoring kidney function.

Where Shih Tzu care fits in a bigger plan

Breed is one variable in a longer calculation. The senior pets page covers senior-care arithmetic, which in this breed is dominated by dental, eye, and airway maintenance. The insurance page covers how to think about BOAS and dental coverage. The breed health map is the hub this page lives under. For shorter pieces on specific conditions, the Veta Journal runs regular updates.

Two specific actions worth taking this week. First, put the dental brushing on a regular evening calendar slot. Twice a week, five minutes, a flavored toothpaste, a finger brush. Second, at the next walk, listen deliberately to how the dog is breathing. That baseline observation, noted in the record, is what a BOAS specialist will want to hear at the next visit.

Questions owners ask about Shih Tzu health

Is the Shih Tzu's flat face a health problem?

Yes, though Shih Tzus are generally less severely affected than French bulldogs or pugs. Brachycephaly, the short skull structure, compresses the airway and causes what's called brachycephalic obstructive airway syndrome, or BOAS. The Merck Veterinary Manual's respiratory chapter describes Shih Tzus as moderately affected, with many individuals having mild to moderate airway restriction that manifests as noisy breathing, exercise intolerance, and heat sensitivity. A smaller fraction has severe BOAS requiring surgical intervention, typically soft palate resection and nares widening. Cornell's BOAS severity scoring framework helps stratify which dogs need surgery versus conservative management.

How long do Shih Tzus typically live?

Shih Tzus commonly live 10 to 18 years, one of the widest lifespan ranges in any breed. The variation reflects how much difference breed-specific management makes. A Shih Tzu with well-managed airway, good dental care, routine eye protection, and early intervention on back problems often reaches fifteen or sixteen. A Shih Tzu whose owner doesn't know about IVDD risk or brachycephaly management may die five years younger. The Royal Veterinary College VetCompass data places the breed firmly in the long-lived small-dog category when management is appropriate.

What should I watch for with my Shih Tzu's breathing?

Loud breathing at rest, snoring that sounds like struggle rather than sleep, reluctance to exercise, and gagging or regurgitation are the signs of BOAS worth flagging. Normal Shih Tzu breathing is audibly present but not labored. When breathing becomes work, especially on walks or during warmer weather, the airway evaluation should happen. A veterinary BOAS specialist can grade severity and recommend whether surgical widening of the airway is indicated. The American Veterinary Medical Association's brachycephalic health position statements support early intervention in dogs with clinically meaningful obstruction. Heat sensitivity is the other signal: Shih Tzus overheat faster than longer-muzzled dogs, and summer care plans need to account for that.

Why are Shih Tzu eyes so prone to injury?

The breed's facial structure places the eyes forward and relatively exposed, and the shortened muzzle means the eyelids don't close completely over the eye in many dogs. The combination makes corneal ulcers, infections, and dry eye syndrome dramatically more common than in breeds with longer muzzles. The Merck Veterinary Manual's ophthalmology chapter flags brachycephalic breeds as high-risk for corneal disease. Signs at home include squinting, pawing at the eye, visible discharge, cloudy areas on the cornea, or redness. Any of these warrants same-day veterinary attention. The threshold for referral to a veterinary ophthalmologist is low in this breed.

Do Shih Tzus need special dental care?

Yes, and earlier than most owners expect. Shih Tzu jaws are small and crowded with full-sized teeth, which accumulates tartar and develops periodontal disease rapidly. Many Shih Tzus have significant periodontal disease by age three or four. The American Veterinary Medical Association's dental-care position statement recommends annual professional dental evaluation for small breeds, and this is unambiguously one of them. Home brushing every two or three days with a toothpaste formulated for dogs starts in puppyhood. A finger brush plus flavored paste is usually enough to win cooperation. The first professional cleaning typically happens between ages two and four, and annual cleanings thereafter prevent extractions.

Can Shih Tzus have back problems like dachshunds?

Yes. Shih Tzus are chondrodystrophic, meaning they carry the same cartilage-development genetics responsible for intervertebral disc disease (IVDD) in dachshunds, though at lower rates. The Merck manual lists the breed among those predisposed. Signs at home include sudden yelping when picked up, reluctance to jump up on furniture, a hunched back, or hindquarter weakness. Any of these is an emergency same-day visit. Prevention parallels dachshund care: avoid jumping on and off high furniture, discourage stair-climbing in young and senior dogs, and maintain lean body condition. Ramps on the couch and bed are the single highest-leverage environmental change.

How active does a Shih Tzu need to be?

Less than most dogs. Shih Tzus are companion breeds, and thirty minutes of daily moderate activity split into short walks and play is adequate for most. The breed's brachycephaly limits tolerance for high-intensity or long-duration exercise, and the small size means stairs and inclines are loaded differently than in larger breeds. Mental stimulation matters more than physical exhaustion. Puzzle feeders, scent games, training practice, and short walks with sniff time generally produce a more settled and healthier dog than long hikes do. The American Animal Hospital Association canine life-stage guidelines endorse activity calibrated to breed and individual, which for Shih Tzus means gentle and frequent.

When does a Shih Tzu's senior care change?

By age nine or ten, wellness visits move to every six months. Full senior workup covers CBC, chemistry with liver and kidney markers, T4, urinalysis, blood pressure, and cardiac auscultation. Dental evaluation continues every visit; extractions are common in senior Shih Tzus with deferred dental histories. Any new cough or change in breathing sound warrants airway re-evaluation, because BOAS can progress slowly with age. Eye exams continue annually, because chronic corneal changes accumulate and cataracts develop in some dogs. The specific cadence gets set by your DVM based on your dog's conditions.

Is pet insurance worth it for a Shih Tzu?

For Shih Tzus, the math depends heavily on what the specific dog has going on. A Shih Tzu with good airway function, no IVDD history, and manageable dental work clears the expected-value bar on a modest policy with a moderate deductible. A Shih Tzu with significant BOAS needing surgery, or any back history, or chronic eye issues, moves into the higher-claim tier where comprehensive coverage pays back. The North American Pet Health Insurance Association's 2024 breed data places Shih Tzus near the median for claim frequency but with a long tail of high-dollar claims in the senior years. Shop by what's covered on hereditary and congenital conditions. The Veta insurance guide walks through comparison.

When Veta is ready

Breed-aware reminders, the day Veta ships.

Veta is the pet health passport being built to hold Shih Tzu-specific dental, eye, and airway reminders plus the short list of small-dog questions worth asking at each visit. One note when iOS is live.

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About the author

Rachel Howland, CVT (ret.)

Rachel Howland, CVT (ret.), spent a decade in clinic: seven years in a mixed practice in upstate New York, then three on the internal-medicine floor at Angell Animal Medical Center in Boston. She left practice in 2017 and has written about small-animal health since. She lives in Somerville with Juno, an 11-year-old hound mix managing chronic kidney disease, and Bishop, a Siamese cat.

Rachel is Veta's lead editorial contributor. She does not diagnose or prescribe; she explains what your vet's records are telling you and what questions are fair to ask.

Sources

Merck Veterinary Manual. Brachycephalic Obstructive Airway Syndrome. merckvetmanual.com.
American Veterinary Medical Association. Pet Dental Care position statement. avma.org.
Cornell University College of Veterinary Medicine. Ophthalmology; brachycephalic corneal disease. vet.cornell.edu.
Orthopedic Foundation for Animals. Patellar luxation and hip databases; small-breed statistics. ofa.org.
American Animal Hospital Association. Canine Life Stage Guidelines. aaha.org.
IRIS (International Renal Interest Society). Chronic kidney disease staging guidelines. iris-kidney.com.