Fixes for finicky felines and picky pooches

"Oh, that food? Not gonna eat it." Photo: Shutterstock.com Some pets prefer to try their hardest to swallow their entire food bowl whole when it comes to dinner time, while some prefer to graze as they continue about their official pet business. But when picky turns to downright inappetence, you know as a veterinary professional that there's a problem. Here are a few of my top tips for handling these picky pooches and finicky felines with ease.

Useful terms for nutritional assessment of pets

> Anorexia: Complete loss of appetite-the pet is not eating or ingesting any calories.

> Hyporexia: Decreased appetite-the pet is eating, but not enough to meet its daily calorie requirements, or at least its resting energy requirements  

> Dysrexia: Change in food preferences-the pet is eating, but not appropriate food (an unbalanced diet or foods not appropriate for a specific medical condition).

> Body condition score: Assessment of a pet's fat stores only. Ideal body condition is described as ribs that are palpable without excess fat covering (tip: ribs should be no more padded than the back of your hand).

> Muscle condition score: Assessment of a pet's muscle by palpation of the spine, skull, scapulae and ileal wings.

Step one: Assessing malnutrition

Assessing the risk of malnutrition can alert the healthcare team when to intervene for a pet and consider additional nutritional support. During normal weight loss, the body of a healthy pet will adapt to calorie restriction and break down fat. However, when a pet has a medical illness, if calorie (and especially protein) needs are not met, the body will not adapt. What happens instead is muscle wasting, caused when pets break down their own muscles to meet their nutrient needs. Here's a quick breakdown of the risks:

> Low risk: Previously healthy pets with no conditions that would increase protein loss (e.g. protein-losing enteropathy) that have been hyporectic or anorectic for three days or less. Examples would be elective surgery or trauma.

> Moderate risk: Non-debilitated pets with conditions that increase protein loss that have been hyporectic or anorectic for three to four days. Examples would be septic patients or a foreign body removal that required intestinal resection.

> High risk: Debilitated pets with chronic conditions that have experienced muscle loss and weight loss, have higher than normal nutrient needs (like puppies and kittens) or have been hyporectic or anorectic for four or more days.

>> Note: For pets that are hospitalized, you should always assess the duration of hyporexia or anorexia-including time at home before hospitalization.

Step two: Nutritional intervention

Strategies and the level of invasiveness for nutritional intervention differ depending on the risk of malnutrition for each pet.

> Medical strategies

Assess the pet's current medications: Many medications may cause nausea or inappetence, including pain medications (opioids) and antibiotics. If use in a low-risk patient is temporary, this may not be a concern. However, pets that require nausea-inducing medications long-term or pets that are already at high risk of malnutrition may need to be switched to alternate dosing or alternate medications. If palatability is a factor, some medications can be composed with tasty flavors at compounding pharmacies. If not, topical or injectable options may be available-for example, injectable antibiotics such as cefovecin sodium.

>> Anti-nausea medications: For pets without alternatives for nausea-inducing medications or those with chronic disease conditions that contribute to nausea, supportive medications can be used to counteract these effects-for example, maropitant citrate.

>> Appetite stimulants: These are best used in low-risk patients that have “forgotten” their appetite and need a jump start. The effects of many of these medications are short-term. Be cautious of pets that eat voraciously for one meal after receiving an appetite stimulant but then return to hyporexia or anorexia within 12 to 24 hours. Examples of medications you can use include diazepam,* cyproheptadine and mirtazapine. One new medication on the market, capromorelin, has potential long-term applications, though further clinical studies are warranted.

> Feeding strategies

To start figuring out strategies, it's important to consider the pet's diet history. Examples of diet history forms can be found here. It's crucial to know a pet's food preferences and offer foods that are familiar to them. Do they like wet food? Dry food? What flavors and textures are their favorite? Many foods are available now as stews, pâté, loaves, shreds or chunks as well as in varying shapes and sizes.

You can suggest several strategies for pet owners to use at home.

>> Disguise pet food: Some pets get excited about eating “human” meals. Tell owners to select one “human” plate that is put on the table and then given to the dog or cat with their meal on it to make pets think they are getting a special treat. Similarly, putting regular kibble into an empty treat pouch or bag can also make pets think they're getting a special treat since it has the same smells and sounds of treats they like.

>> Home-cooked diet options: If there are no commercial diets appropriate for a pet's medical condition that it will eat, home-cooking can be an alternative option. This is also common in pets that have been fed table scraps long-term and find it hard to then switch back to a commercial diet. Important note: Pets should only be fed home-cooked diet recipes that have been formulated by a board-certified veterinary nutritionist (a list can be found here). Many studies have shown that recipes online or in books are not complete and balanced and may cause nutrient deficiencies.

> Medication administration strategies

Caution should be used when it comes to putting medications directly into pet foods, especially those with bitter taste, as they may unintentionally cause a food aversion or affect appetite. Treat pockets that pills can be placed inside are commercially available if the pet has no nutritional restrictions. An alternate low-fat, low-protein, low-sodium option is to use bananas (a ¼-inch slice is 15 kcal) or melons (1 melon ball is 10 kcal) to give medications. Remember to always ask owners what they are using for medication administration, since it's not commonly included in diet histories (owners don't think of this as “food”).

> Behavioral strategies

In some situations, particularly those involving pets with chronic diseases, owners can become very invested in their pets' eating habits and become anxious over how much their pets are eating. This anxiety can spill over to their pets, which may not understand why their owners get very upset at mealtimes. Pets then sometimes associate eating or mealtime with something wrong or upsetting. This can be seen where pets eat normally when pet sitters are involved or a family member leaves the household temporarily.

To help identify and eliminate this factor, have owners explain mealtime in detail and ask about all family members as well as other pets, which sometimes may also contribute to stressful mealtimes if there is fighting over food bowls. Anxious owners can leave food in timed automatic feeders or place the food and their pet in a quiet, separate room in their house where the pet is left alone to eat. Alternatively, for social pets, tell owners to talk to their pets in a soft soothing voice and pet them while they eat to encourage appetite and make mealtime more enjoyable.

*Oral diazepam may cause acute hepatic failure and death in cats. (Center SA, Elston TH, Rowland PH, et al. Fulminant hepatic failure associated with oral administration of diazepam in 11 cats. J Am Vet Med Assoc 1996;209(3):618-625; Park FM. Successful treatment of hepatic failure secondary to diazepam administration in a cat. J Feline Med Surg 2012;14(2):158-160.)

Dr. Linder is the director at Tufts Obesity Clinic for Animals in North Grafton, Massachusetts.