Puppy First, Health First
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The big picture
Maltese typically live 12–15 years, and most enjoy long lives as healthy little companions.
The breed's parent club, the American Maltese Association, describes a healthy breed whose main expected problems come with age: cataracts, heart murmurs and dental work.
A few everyday habits do much of the work.
Maltese are known to be prone to a handful of conditions, and most are easier to manage when they are caught early.
This page explains each one in plain words: what it is, what you might notice and what you can do.
Worth knowing
This list is not exhaustive or official. Keep asking your veterinarian as your puppy grows.
A slipping kneecap (patellar luxation) pops out of its groove, usually toward the inside of the leg. Among Maltese checked by the Orthopedic Foundation for Animals (OFA), which keeps the results owners send in, about 5 in 100 had an abnormal knee result.
Watch for a limp on a back leg, and ask your vet to feel the knees at routine visits.
Most affected Maltese have milder grades, and a lean weight and fewer jumps help protect the knees.
In tracheal collapse, the windpipe weakens and narrows over time, usually from middle age.
A honking cough, a bit like a goose, is the usual sign.
Walk your Maltese on a harness instead of a neck collar and keep it lean, because pressure on the neck can set off the cough.
A liver shunt is a blood vessel, present from birth, that lets blood bypass the liver. Many Maltese also have microvascular dysplasia, a milder blood-flow difference inside the liver that almost never causes signs.
Signs of a shunt usually show in young dogs, so a bile acids blood test from 4 months of age is the usual first check.
A high result needs more tests to tell the two apart, and your vet checks the liver before any planned surgery.
In patent ductus arteriosus, a blood vessel near the heart that should close after birth stays open.
Your vet hears it as a constant murmur, so a careful listen at the first puppy visits matters.
If your vet hears a murmur, the next step is a heart scan (echocardiogram).
A cataract is a clouding of the lens inside the eye, and in the Maltese it mostly comes with age. Eye specialists found significant cataracts in about 1 in 10 of the Maltese they examined.
Watch for cloudiness in an eye, and have the eyes checked at senior exams.
A veterinary eye specialist (ophthalmologist) can examine the eyes at any age.
Small mouths build up tartar easily, and gum disease, crowded teeth and baby teeth that stay in are common in toy breeds like the Maltese.
Check the mouth as the adult teeth come in, and show your vet any baby tooth that stays put.
Brush the teeth every day if you can, and plan professional cleanings when your vet advises.
Less common
Brain inflammation (necrotizing meningoencephalitis) needs a vet right away at sudden signs such as seizures, circling or loss of balance.
Low blood sugar can affect tiny puppies until about 3–4 months, and most grow out of it.
Legg-Calvé-Perthes disease, where the top of the thigh bone loses its blood supply, can cause a back-leg limp in young dogs.
Fluid on the brain (hydrocephalus) is present from birth and more likely in puppies with a very round skull.
Fluid pockets in the spinal cord linked to skull shape (Chiari-like malformation and syringomyelia) have been reported in the breed.
Long-term gut inflammation (inflammatory bowel disease), sometimes with protein loss through the gut, can affect the breed.
A testicle that fails to come down (cryptorchidism) is not uncommon in males, and your vet checks for it.
A worn heart valve (mitral valve disease) often causes a murmur once a Maltese reaches double digits in age.
An underactive thyroid (hypothyroidism) turns up in the breed from time to time.
Extra eyelashes along the eyelid edge (distichiasis) occur in the breed, and an eyelid check at the vet picks them up.
DNA tests
A cheek-swab DNA test works at any age. For the Maltese, it can check for glycogen storage disease type Ia, an inherited illness first found in Maltese puppies that causes dangerously low blood sugar. The parent club regards it as very uncommon.
Results come back as clear, carrier or at risk. A carrier has one copy of the gene change and stays healthy. Some test panels also look for a gene change linked to early wear of the spinal discs (CDDY). That result is a risk factor, not a diagnosis: a dog with it may never develop disc problems.
Checkups your dog will get
Care plan by life stage
Planning for Maltese vet costs
These are typical published costs for treating what a Maltese vet exam looks at and the conditions the breed is known to be prone to. Each range shows where it comes from and when, and your own vet's estimate will differ.
| Item | Typical cost | Per | Source | Year |
|---|---|---|---|---|
| Specialist's first exam (consultation fee only) | $198–$350 | per visit | at US veterinary teaching hospitals (Michigan, Missouri, Tennessee) | 2023–2026 |
| Eye tests before cataract surgery (ERG and eye ultrasound) | $500–$1,300 | per workup | at US veterinary teaching hospitals (Missouri, Tennessee) | 2025–2026 |
| Cataract surgery, one eye | $3,800–$5,500 | per eye | at one US veterinary teaching hospital (Missouri) | 2023–2025 |
| Cataract surgery, both eyes under one anesthetic | $5,600–$6,700 | at one US veterinary teaching hospital (Missouri) | 2025 |
| Item | Typical cost | Per | Source | Year |
|---|---|---|---|---|
| Specialist's first exam (consultation fee only) | $198–$350 | per visit | at US veterinary teaching hospitals (Michigan, Missouri, Tennessee) | 2023–2026 |
| Item | Typical cost | Per | Source | Year |
|---|---|---|---|---|
| Liver shunt workup (before any surgery) | $1,622–$3,937 | per workup | at one US veterinary teaching hospital (Tennessee) | 2026 |
| Liver shunt surgery, shunt outside the liver (workup and surgery) | $5,408–$7,571 | per procedure | at one US veterinary teaching hospital (Tennessee) | 2026 |
| Liver shunt surgery, shunt inside the liver, open surgery (workup and surgery) | $6,685–$9,605 | per procedure | at one US veterinary teaching hospital (Tennessee) | 2026 |
| Liver shunt closure with coils through a vein (workup and procedure) | $10,600–$12,309 | per procedure | at one US veterinary teaching hospital (Tennessee) | 2026 |
| Item | Typical cost | Per | Source | Year |
|---|---|---|---|---|
| Collapsing trachea workup (before a stent) | $2,000–$3,500 | per workup | at one US veterinary teaching hospital (Missouri) | 2023 |
| Tracheal stent placement | $3,200–$3,600 | per procedure | at one US veterinary teaching hospital (Missouri) | 2023 |
| Tracheal stent, workup and placement together | $5,900–$6,500 | per procedure | at one US veterinary teaching hospital (Missouri) | 2023 |
Planning for pet insurance
When you are ready to compare plans, here is one option for Pawrade buyers.
Only with Pawrade, you receive a pet insurance policy with no waiting period included for immediate accident or illness coverage, 1 month, with every puppy.† You activate it by calling MetLife; instructions arrive with your travel details. Continuing MetLife coverage after the first month is strongly recommended.
View the MetLife 30-day offer →†NH, NY, RI, SC and TN residents excluded. Activated by calling MetLife; coverage begins immediately following policy activation. See the offer for full terms.
Whichever plan you look at, read the policy before you buy. Check the waiting periods, how it defines a pre-existing condition, and its deductible, reimbursement percentage and annual limit.
A waiting period is how long after you buy a pet insurance policy before a claim counts.
| Policy | Accidents | Illness | Joints |
|---|---|---|---|
| MetLife policy included with your Pawrade puppy† | None | None | None |
| MetLife, bought directly | None | 14 days | Not listed |
| Industry standard | 0–14 days | 14–30 days | 6–12 months |
| Nationwide | 14 days | 14 days | Not listed |
| Trupanion | 5 days | 30 days | 30 days |
| Embrace | 2 days | 14 days | 6 months |
| Figo | 1 day | 14 days | Not listed |
The breeder's licensed vet checks your puppy before it goes home. The vet follows PetPay's exam standards, and the results go in your puppy's Veterinary Health Report.
Focus
Heart
Heart murmur, and how loud it is (grade)
02
Breathing
How open the nostrils are · Coughing or congestion
03
Temperature, pulse and breathing rate
Temperature · Pulse · Breathing rate
04 Focus
Eyes
Discharge · Vision problems · Eyelash problems · Cherry eye
05
Ears and hearing
Debris or discharge · Ear mites · Signs of infection · Hearing
06 Focus
Mouth and bite
Teeth and jaw alignment · Bite (overbite or underbite)
07
Skin and coat
Fleas and ticks · Hair loss · Signs of infection
08 Focus
Kneecaps
Kneecaps that slip, and how much (grade)
09
Hips
Hip pain
10
Hernias
Belly-button (umbilical) hernia · Groin (inguinal) hernia
11
Soft spot on the skull
An open soft spot, and its size
12
Body condition and weight
Body condition score · Weight
13 Focus
Reproductive organs
Both testicles in place (males) · Extra skin folds around the vulva (females)
14
History of vomiting or diarrhea
Any history of vomiting or diarrhea (reported, not examined)
15
Stool test for parasites
Fecal flotation test, with any treatment given
16
Past surgery and notes
Any past surgery · The vet's explanation of anything abnormal
The vet listens to the heart for a murmur.
Maltese can be born with an open blood vessel near the heart (patent ductus arteriosus), which makes a distinctive murmur. A murmur is usually followed up with a heart scan (echocardiogram).
The vet checks the eyes for extra lashes and watery discharge.
In a Maltese, a tear duct opening that never formed can cause constantly watery eyes. Eyelids that roll inward are something to watch for as your puppy grows.
The vet looks in the mouth to see how the teeth meet, and a slightly undershot bite is no cause for worry in a pet.
The vet feels each knee to check that the kneecap stays in place.
A slipping kneecap (patellar luxation) runs in the breed, and a lean weight helps protect the knees.
In a male puppy, the vet feels for both testicles, which in toy puppies can drop a little later and are checked again as the puppy grows.
The vet listens to the heart for a murmur.
Maltese can be born with an open blood vessel near the heart (patent ductus arteriosus), which makes a distinctive murmur. A murmur is usually followed up with a heart scan (echocardiogram).
The vet checks the eyes for extra lashes and watery discharge.
In a Maltese, a tear duct opening that never formed can cause constantly watery eyes. Eyelids that roll inward are something to watch for as your puppy grows.
The vet looks in the mouth to see how the teeth meet, and a slightly undershot bite is no cause for worry in a pet.
The vet feels each knee to check that the kneecap stays in place.
A slipping kneecap (patellar luxation) runs in the breed, and a lean weight helps protect the knees.
In a male puppy, the vet feels for both testicles, which in toy puppies can drop a little later and are checked again as the puppy grows.
Puppies grow and change quickly, and their immune systems are still developing, so no exam can find everything. The Veterinary Health Report is a strong early look at your puppy and a written starting point that your own vet builds on.
Health guarantee
Every Pawrade puppy comes with a health guarantee administered by PetPay, independent of the seller. The terms are on the health guarantee page.
Customers Love Us!
Cleo · Maltese“Thank you so much. My little Maltese puppy arrived on time and with the upmost care. I've had great communication and follow ups through the entire adoption.”
Maltese Puppies for Sale
Frequently asked questions
Most Maltese live long lives, and a handful of conditions run in the breed that everyday care and checkups help with. They include a slipping kneecap (patellar luxation), a weak windpipe (tracheal collapse) and a liver shunt (portosystemic shunt). A heart defect from birth (patent ductus arteriosus), brain inflammation (necrotizing meningoencephalitis) and cataracts complete the list. A lean weight, a harness, daily tooth care and a vet who listens to the heart and checks the liver help you stay ahead of them.
Tracheal collapse is a weak, narrowing windpipe that causes a honking cough, usually from middle age. A harness helps, because pressure on the neck from a collar can set off the cough.
A liver shunt is a blood vessel present from birth that lets blood bypass the liver. A bile acid blood test from 4 months of age screens for it, so ask your vet about the timing. A high result needs more tests, because many Maltese have a milder liver blood-flow difference (microvascular dysplasia) that also raises it.
Hypoglycemia is low blood sugar, a risk in tiny puppies from weaning to about 3–4 months that most outgrow. Feed small meals often, keep the puppy warm and rested, and keep a glucose gel on hand to rub on its gums if it seems weak.
A cheek-swab test checks for glycogen storage disease type Ia, an inherited illness first found in Maltese puppies. Some panels also report a gene change linked to early wear of the spinal discs (CDDY).
A carrier has one copy of the gene change and stays healthy. A risk result is not a diagnosis, and a dog with the disc-disease risk change may never develop disc problems.
Maltese typically live 12–15 years. In the senior years, checkups that listen for a new heart murmur and look for cataracts help your vet catch changes early.
Older Maltese do best with a vet who listens for new heart murmurs and checks the eyes for cataracts. Keep up dental cleanings, and mention any cough or loss of stamina.
Brush them often, ideally every day, and plan professional cleanings, because toy mouths are prone to tartar and gum disease. Baby teeth that do not fall out, especially the canines, should be removed by a vet.
When to spay or neuter is a decision to make with your own vet, because it depends on your dog. Any baby teeth that stayed in are often removed during that surgery.
Keep your Maltese lean, walk it on a harness, care for its teeth every day and book a yearly exam that includes a listen to the heart.
