Newborn Foal Exam: What To Check in the First 24 Hours

By Dr Duncan Houston

The first day of a foal’s life is not just a cute photo opportunity. It is the window where immunity, nursing, gut function, breathing, temperature control, limb development, and early infection risk all need to be assessed properly.

Many foals look normal at birth and then start showing problems a few hours later. Others are born weak, slow, confused, painful, or unable to nurse properly. The tricky part is that a foal can be standing and still not be safe. It may have poor colostrum transfer, early sepsis, meconium retention, a painful umbilicus, limb problems, abnormal breathing, or early signs of neonatal maladjustment syndrome.

A newborn foal exam is designed to catch problems early, while treatment is still much more effective.

Quick Answer

A newborn foal should be monitored immediately after birth and examined by a veterinarian within the first 12 to 24 hours, even if the foaling looked normal. The exam should check the foal’s nursing, IgG level, attitude, temperature, heart and lungs, joints, limbs, eyes, umbilicus, hernias, meconium passage, urination, and signs of infection or neonatal maladjustment. Colorado State University recommends the 1-2-3 rule: the foal should stand within 1 hour, nurse within 2 hours, and the mare should pass the placenta within 3 hours, with a veterinary newborn exam and IgG blood test between 12 and 24 hours after foaling. (Vet Med & Biosciences College)

Why the First 24 Hours Matter

Foals are born with very little immune protection. They depend on colostrum, the mare’s first milk, to absorb immunoglobulins, especially IgG, through the gut. That absorption window closes quickly, so timing matters. Cornell notes that foals can only absorb IgG during the first 18 to 24 hours of life, and if the foal has low IgG after that window, IV plasma becomes the option rather than oral colostrum. (Cornell Vet College)

That is why “wait and see” can be dangerous in newborn foals. A weak suckle at 2 hours is not just a feeding issue. It can become an immunity issue. A slightly dull foal may not just be tired. It may be septic, hypoxic, premature, dysmature, painful, or neurologically abnormal.

The aim of the first-day exam is simple: confirm the foal is transitioning normally, absorbing colostrum, passing meconium, bonding with the mare, and not showing early signs of disease.

The 1-2-3 Rule for Newborn Foals

The 1-2-3 rule is one of the easiest ways to remember the first major milestones.

Time After Birth	What Should Happen	Why It Matters
1 hour	Foal should stand	Weakness, pain, hypoxia, prematurity, or illness may delay standing
2 hours	Foal should nurse	Colostrum intake is time-critical
3 hours	Mare should pass placenta	Retained placenta can cause serious illness in the mare

Colorado State University states that a healthy newborn foal should stand within 1 hour, start nursing within 2 hours, and the mare should pass the placenta within 3 hours. Failure to meet those milestones should prompt veterinary contact. (Vet Med & Biosciences College)

There is some normal variation, and not every foal reads the textbook. But in practice, missing these milestones is not something to shrug off. A newborn foal has very little reserve. If it is slow, weak, or not nursing, the clock is already running.

What Should a Newborn Foal Exam Include?

A proper newborn foal exam is not just checking whether the foal is alive and standing. Your vet is looking for early problems that owners can easily miss.

A first-day foal exam commonly includes:

• General attitude and strength

• Nursing behaviour

• Suckle reflex

• Temperature

• Heart and lung assessment

• Mucous membrane colour

• Hydration

• Umbilicus and navel stump

• Umbilical or inguinal hernias

• Limb alignment

• Tendon laxity or contracture

• Joint swelling or pain

• Eye checks

• Meconium passage

• Urination

• IgG blood test

• Mare behaviour and udder emptying

• Placenta examination

• Risk assessment for sepsis or failure of passive transfer

Cornell recommends calling a veterinarian within the first 12 to 24 hours for a check-up, and notes that the vet will examine the foal, check IgG levels, and also assess the mare and placenta. (Cornell Vet College)

IgG Testing: The Check You Should Not Skip

IgG testing is one of the most important parts of the newborn foal exam.

Foals do not receive meaningful passive immunity through the placenta. They rely on absorbing antibodies from colostrum after birth. Colorado State University specifically notes that foals do not get passive transfer in the womb, which is why the post-foaling IgG test matters. (Vet Med & Biosciences College)

The usual interpretation is:

IgG Level	Meaning	Typical Concern
Less than 400 mg/dL	Complete failure of passive transfer	High infection risk
400 to 800 mg/dL	Partial failure of passive transfer	Risk depends on foal and environment
More than 800 mg/dL	Adequate passive transfer	Usually acceptable

Merck Veterinary Manual defines complete failure of transfer of passive immunity in foals as serum IgG below 400 mg/dL at 24 hours, with partial failure associated with 400 to 800 mg/dL. It also notes that high-risk foals with IgG at or below 800 mg/dL may need IV equine plasma. (Merck Veterinary Manual)

The practical point: a foal can look normal and still have low IgG. You cannot reliably eyeball passive transfer.

What If the IgG Is Low?

If IgG is low and the foal is still young enough, your vet may recommend high-quality colostrum or a colostrum replacer. If the foal is older, sick, high-risk, or the gut absorption window has closed, IV plasma may be needed.

The University of Illinois explains that colostrum treatment is only effective within the first 24 hours, and after that, foals with failure of passive transfer are treated with plasma containing antibodies. It also recommends a veterinary exam and antibody test around 12 hours after birth so problems can be detected early. (Veterinary Medicine at Illinois)

This is the reason I like the 12-hour check. It gives you time to act before the door closes.

Tetanus: Does Every Newborn Foal Need Antitoxin?

Not always.

The best tetanus protection starts before foaling. AAEP recommends vaccinating broodmares 4 to 6 weeks before foaling to maximise immunoglobulin concentration in colostrum, but also notes that vaccinating the mare is not enough by itself because the foal still needs to receive and absorb adequate colostrum. (AAEP)

Tetanus antitoxin may be indicated for passive protection when a foal is born to a non-vaccinated mare and is at risk of tetanus infection. AAEP specifically states that tetanus antitoxin is indicated in situations where a foal is born to a non-vaccinated mare and is at risk. (AAEP)

So the correct decision is not “give every foal antitoxin” or “never give it.” The correct decision depends on:

• Mare vaccination history

• Colostrum intake

• IgG result

• Foaling environment

• Umbilical health

• Wound risk

• Local veterinary protocol

If the mare was properly vaccinated before foaling and the foal has adequate passive transfer, routine tetanus antitoxin is often not needed. If the mare was unvaccinated, vaccination history is unknown, or passive transfer failed, your vet may recommend additional protection.

Umbilicus and Navel Checks

The umbilicus is one of the most important infection entry points in a newborn foal. It should be checked for size, swelling, heat, pain, discharge, bleeding, urine leakage, and herniation.

A normal umbilical stump should dry down gradually. It should not be wet, foul-smelling, dripping pus, enlarged, painful, or leaking urine.

Your vet may check for:

• Omphalitis, which is umbilical infection

• Patent urachus, where urine leaks from the umbilicus

• Umbilical hernia

• Umbilical abscess

• Excessive bleeding

• Thickened internal umbilical remnants

If the umbilicus looks abnormal, ultrasound may be needed. Umbilical infections can spread internally and may be associated with sepsis or joint infection.

Umbilical and Inguinal Hernias

A newborn exam should include palpation of the umbilical area and, especially in colts, the inguinal and scrotal region.

Umbilical hernias are relatively common in foals. Some are small and monitored, while others need veterinary management if they are large, painful, non-reducible, infected, or associated with colic. Inguinal hernias can also be seen in young foals, and although many are not emergencies in babies, they still need proper assessment. The University of Minnesota’s large animal surgery text notes that inguinal hernias in babies often resolve over time, but they still require correct identification and monitoring. (Publishing Services)

Call your vet urgently if a hernia becomes firm, painful, hot, non-reducible, or the foal shows colic signs.

Meconium: The First Stool Matters

Meconium is the foal’s first manure. It is dark, firm, sticky material passed after birth. If it does not pass properly, the foal can develop meconium impaction, which is one of the most common causes of colic in newborn foals.

Signs of meconium retention include:

• Straining

• Tail raising

• Repeated attempts to defecate

• Restlessness

• Belly discomfort

• Lying down and getting up

• Reduced nursing

• Abdominal distension

• Colic signs

Merck Veterinary Manual states that many meconium impactions respond to medical therapy including fluids, analgesics, laxatives, and enemas. It also notes that warm-water liquid detergent enemas are preferred, while commercial phosphate enemas can be used but repeated administration may increase the risk of phosphate toxicity. (Merck Veterinary Manual)

That means enemas are not a “more is better” situation. A single routine enema is used on some farms, but repeated enemas or ongoing straining should involve a vet. The foal’s rectum is delicate, and not every straining foal simply has an easy meconium plug.

Should Every Foal Get an Enema?

This depends on farm protocol and veterinary advice.

Some breeding farms routinely give a gentle enema shortly after birth. Others only treat if the foal has not passed meconium or is showing signs of retention. Both approaches can be reasonable depending on the setting, but repeated phosphate enemas without veterinary guidance are not safe.

A practical approach:

• If the foal passes meconium normally, monitor.

• If the foal is straining but bright and nursing, call your vet for advice.

• If the foal is colicky, bloated, dull, not nursing, or still straining after an enema, treat it as urgent.

• Do not keep giving repeated enemas hoping to force a result.

The goal is to help the foal pass meconium without causing rectal irritation, electrolyte problems, or missing a more serious issue.

Urination Checks

A newborn foal should urinate in the first hours of life. Colts may take longer than fillies, and normal urination can look a little awkward at first. Merck notes that first urination is variable, fillies usually urinate before colts, and it is not unusual for a colt not to fully drop the penis for the first few days because of a normal temporary tissue frenulum. (Merck Veterinary Manual)

Things that are not normal include:

• Straining repeatedly without urine

• Urine dripping from the umbilicus

• Swollen belly

• Dullness

• Colic signs

• Repeated attempts to urinate with no result

Urine from the umbilicus can suggest a patent urachus and needs veterinary attention.

Limb, Joint and Tendon Checks

Newborn foals are often a bit wobbly. Some mild laxity or awkward movement can improve with time. But there is a big difference between normal newborn looseness and a foal with serious limb disease.

Your vet should assess:

• Limb alignment

• Flexural deformities

• Tendon laxity

• Contracted tendons

• Joint swelling

• Joint pain

• Heat around joints

• Ability to stand and move

• Hoof and fetlock position

• Signs of trauma from birth

A hot, swollen, painful joint in a foal is always concerning. Septic arthritis, often called joint ill, can develop from bloodstream infection and can permanently damage joints if treatment is delayed. Merck lists failure of passive transfer, unsanitary conditions, prematurity, difficult birth, poor mare condition, and new environmental pathogens as factors that increase sepsis risk in foals. (Merck Veterinary Manual)

The danger is that joint infection does not always look dramatic at first. A foal may simply be a bit dull, less keen to nurse, or slightly lame before it becomes obvious.

Eyes and Eyelids

A newborn foal exam should also include the eyes. Foals can be born with or develop problems such as:

• Entropion, where the eyelid rolls inward

• Corneal ulceration

• Cloudiness

• Eye trauma

• Swelling

• Abnormal reflexes

• Blindness or poor visual response

Entropion matters because the eyelashes or hair can rub against the cornea and create an ulcer. This is often fixable, but it should be caught early.

If a foal is squinting, tearing, keeping an eye closed, has a cloudy eye, or seems visually abnormal, it needs veterinary assessment.

Breathing, Heart and Temperature

The newborn foal exam should assess whether the foal has made a normal transition from life inside the uterus to breathing and circulating properly outside it.

Your vet will check:

• Breathing pattern

• Lung sounds

• Heart rate and rhythm

• Pulse quality

• Mucous membrane colour

• Capillary refill time

• Temperature

• Hydration

• General strength

Merck states that for compromised neonatal foals, establishing an airway and breathing for the foal is the first resuscitation priority, and that foals not spontaneously breathing are assumed to be in secondary apnea. (Merck Veterinary Manual)

Call your vet immediately if the foal is gasping, not breathing normally, blue or grey in the gums, collapsed, cold, or unable to sit upright.

Neonatal Maladjustment Syndrome and the Madigan Squeeze

Neonatal maladjustment syndrome, often called “dummy foal syndrome,” describes foals that appear neurologically abnormal after birth. They may seem detached, confused, unresponsive, disoriented, weak, or unable to nurse properly.

Signs can include:

• Wandering away from the mare

• Not recognising the udder

• No suckle or poor suckle

• Excessive sleepiness

• Seizures

• Abnormal vocalisation

• Unusual behaviour

• Failure to bond

• Dullness

• Recumbency

UC Davis describes neonatal maladjustment syndrome foals as appearing normal at birth but later showing neurological abnormalities, often becoming detached, disoriented, confused, and having trouble nursing. It also describes the Madigan Squeeze Technique as applying pressure to the ribcage with ropes for around 20 minutes to mimic birth canal pressure. (Center for Equine Health)

The key clinical point: a dummy foal is not a DIY diagnosis. Foals with sepsis, hypoxia, prematurity, failure of passive transfer, trauma, metabolic problems, or infection can look similar.

The Madigan squeeze may help selected foals, but it should be done by someone properly trained or under veterinary guidance. It should not delay colostrum, plasma, antibiotics, oxygen, warming, glucose support, seizure control, or referral when those are needed.

Should Newborn Foals Receive Antibiotics?

Not every newborn foal needs antibiotics.

Antibiotics may be appropriate for foals that are septic, high-risk, premature, dysmature, weak, have low IgG, have umbilical infection, have joint infection, were born from a high-risk pregnancy, or come from farms with specific neonatal infection patterns. But routine antibiotics for every healthy foal are controversial.

A 30-day foal disease incidence study reported that its findings did not support the traditional prophylactic use of antimicrobials to prevent infectious disease in healthy newborn foals. (PubMed)

In practice, antibiotics should be based on risk, examination findings, bloodwork, IgG status, farm history, and veterinary judgement. Overuse can contribute to resistance, alter gut flora, and create a false sense of security.

A foal with low IgG and a dirty umbilicus is a very different patient from a bright foal that stood, nursed, passed meconium, has a normal exam, and has adequate IgG.

Severity and Risk Framework

Low Risk: Normal Foal, Normal Milestones

This foal stands within the expected window, nurses well, stays close to the mare, is bright and responsive, passes meconium, urinates, and has a normal exam with adequate IgG.

What to do: continue monitoring, keep the environment clean, check nursing regularly, and follow your vet’s routine plan.

Medium Risk: Slightly Slow but Improving

This foal is a little slow to stand or nurse but is bright, warming up, improving, and showing a suckle reflex.

What to do: contact your vet for advice, increase observation, confirm colostrum intake, and do not miss the 12 to 24 hour exam and IgG test.

High Risk: Weak, Slow, Not Nursing Properly, or Abnormal Exam

This foal is slow to rise, weak to suckle, not staying with the mare, mildly dull, cold, has an abnormal umbilicus, or has delayed meconium passage.

What to do: call your vet promptly. This foal may need colostrum support, plasma, warming, fluids, bloodwork, or further investigation.

Critical Risk: Emergency Foal

This foal cannot stand, cannot nurse, is not breathing normally, is collapsed, has seizures, has no suckle, has swollen painful joints, has severe colic, has urine from the umbilicus, has abnormal gum colour, or is rapidly deteriorating.

What to do: this is urgent. Call your vet immediately and prepare for possible referral.

What Else Can Look Like a “Slow Foal”?

A slow newborn foal should never be written off as “just tired” until the important problems have been considered.

Important rule-outs include:

Failure of Passive Transfer

The foal may look normal but have low IgG, leaving it vulnerable to infection.

Sepsis

Sepsis can cause dullness, fever or low temperature, poor nursing, swollen joints, diarrhoea, weakness, or collapse. Failure of passive transfer is a major risk factor for sepsis in foals. (Merck Veterinary Manual)

Neonatal Maladjustment Syndrome

The foal may be confused, detached, unable to nurse, or neurologically abnormal. It may need supportive care, not just a squeeze technique.

Prematurity or Dysmaturity

Premature or dysmature foals may be weak, small, silky-coated, lax in the tendons, unable to regulate temperature, and poor at nursing.

Meconium Impaction

A foal that strains, stops nursing, or develops colic signs may have retained meconium.

Umbilical Infection

A swollen, painful, wet, or foul-smelling umbilicus can be an early sign of infection.

Joint Ill

A lame foal or foal with hot, swollen joints needs urgent assessment.

Neonatal Isoerythrolysis

This is a less common but serious condition where the foal ingests antibodies in colostrum that attack its red blood cells. Colorado State University explains that affected foals may appear normal at birth but develop weakness, jaundice, increased respiratory rate, and red-coloured urine within 24 to 72 hours after ingesting incompatible colostrum. (CSU Veterinary Health System)

Birth Trauma

Hard pulls, dystocia, rib fractures, limb trauma, swelling, bruising, and oxygen deprivation can all make a foal slow or painful.

When Is This an Emergency?

Call your vet immediately if:

• The foal does not stand within the expected time

• The foal does not nurse properly

• The foal has no suckle reflex

• The foal is dull, confused, or wandering away from the mare

• The foal is not breathing normally

• The gums are blue, grey, white, or very pale

• The foal is cold, collapsed, or weak

• The foal has seizures

• The foal has swollen or painful joints

• The foal is lame

• The foal has diarrhoea, fever, or depression

• The foal is straining or colicky

• The foal has not passed meconium

• Urine is dripping from the umbilicus

• The umbilicus is swollen, hot, wet, painful, or foul-smelling

• The mare rejects the foal

• The mare will not allow nursing

• The placenta has not passed within 3 hours

• The placenta looks incomplete or abnormal

Merck states that if fetal membranes are retained for more than 3 hours, veterinary treatment is necessary because severe sepsis or laminitis can result in the mare. (Merck Veterinary Manual)

The mare is part of the newborn exam too. A sick mare can quickly become a sick foal problem.

What Should You Do After the Foal Is Born?

1. Watch Quietly but Closely

Let the mare and foal bond, but monitor properly. Do not constantly interfere unless something is wrong.

2. Record the Time of Birth

This anchors every decision that follows: standing, nursing, meconium, placenta, IgG testing, and treatment timing.

3. Use the 1-2-3 Rule

If the foal is not standing, nursing, or progressing on time, call your vet.

4. Confirm Real Nursing

Do not assume the foal is nursing just because it is bumping the udder. Look for proper latch, swallowing, milk on the lips, udder softening, and repeated successful feeds.

5. Save the Placenta

Do not throw it away. Your vet may need to check that it is complete and not thickened, torn, infected, or abnormal.

6. Check Meconium and Urination

Make sure the foal passes meconium and urinates. Straining, colic, or urine from the navel needs veterinary attention.

7. Keep the Foaling Area Clean

The first day is not the time for dirty bedding, wet stalls, or contaminated navels.

8. Book the New Foal Exam

Even if the foal looks good, organise a veterinary exam and IgG test in the first 12 to 24 hours.

9. Do Not Guess With Drugs

Do not give antibiotics, NSAIDs, enemas, sedatives, or supplements without proper veterinary direction.

10. Escalate Early

Foals can decline quickly. Early intervention is almost always easier than trying to rescue a foal that has been fading for hours.

Common Mistakes Owners Make

Assuming Standing Means the Foal Is Safe

Standing is only one milestone. The foal still needs to nurse, absorb colostrum, pass meconium, stay warm, and show normal behaviour.

Skipping the IgG Test

A normal-looking foal can still have failure of passive transfer. That is why the blood test matters.

Thinking the Mare’s Vaccines Protect the Foal Automatically

The mare’s vaccines help colostrum quality, but the foal still has to drink and absorb enough colostrum.

Overusing Enemas

One enema may be part of a protocol. Repeated enemas without veterinary help can cause problems and may delay proper treatment.

Trying the Madigan Squeeze Instead of Calling the Vet

A neurologically abnormal foal needs assessment. The squeeze technique is not a substitute for diagnosing sepsis, hypoxia, failure of passive transfer, or metabolic disease.

Giving Antibiotics “Just in Case”

Antibiotics are not a substitute for hygiene, colostrum, IgG testing, and a proper exam. They should be used when risk or clinical findings justify them.

Forgetting to Check the Mare

Retained placenta, poor milk production, rejection, pain, colic, or post-foaling illness in the mare can all put the foal at risk.

Prevention: Setting the Foal Up Before Birth

Good newborn foal care starts before the foal is born.

Before foaling, you should:

• Vaccinate the mare 4 to 6 weeks before foaling as advised by your vet

• Check whether a Caslick’s needs to be opened

• Prepare a clean foaling area

• Use clean straw bedding if foaling indoors

• Have a foaling kit ready

• Set up cameras or foaling alarms if needed

• Have clean towels and navel disinfectant ready

• Know your vet’s emergency number

• Have colostrum backup access if your mare is high risk

• Know the 1-2-3 rule

• Know what red bag delivery looks like

• Plan the 12 to 24 hour newborn exam

• Save the placenta for inspection

• Record all times and observations

The calmest foaling nights usually come from boring preparation. Boring is good. Boring means the kit is ready, the vet number is saved, the mare is monitored, and nobody is searching for a torch at 2 am while the foal is already behind schedule.

FAQ

Does every newborn foal need a vet exam?

Yes, a newborn foal exam is strongly recommended within the first 12 to 24 hours, even after a normal foaling. The foal may look healthy but still have low IgG, subtle infection, limb problems, umbilical issues, or poor nursing.

When should IgG be tested in a foal?

IgG is commonly tested around 12 to 24 hours after birth. Testing around 12 hours gives time to intervene while oral colostrum may still be useful. After gut absorption closes, plasma is usually needed if IgG is inadequate. (Cornell Vet College)

What is a good IgG level for a foal?

An IgG level above 800 mg/dL is generally considered adequate. A level below 400 mg/dL is complete failure of passive transfer, and 400 to 800 mg/dL is partial failure of passive transfer. (Merck Veterinary Manual)

Should I give my foal an enema?

Some farms use a routine gentle enema, while others only use one if meconium has not passed or the foal is straining. Do not give repeated enemas without veterinary advice, especially phosphate enemas, because repeated use may increase the risk of phosphate toxicity. (Merck Veterinary Manual)

Is the Madigan squeeze safe to do myself?

It should only be done by someone properly trained or under veterinary guidance. A foal that seems dummy, confused, weak, or unable to nurse may have neonatal maladjustment syndrome, but it may also have sepsis, hypoxia, low IgG, prematurity, or another serious disease.

Final Thoughts

A newborn foal exam is not just routine paperwork. It is one of the most important health checks that foal will ever have.

The key questions are simple: did the foal stand, did it nurse, did it absorb colostrum, did it pass meconium, is the umbilicus healthy, are the joints normal, is the mare well, and is anything about the foal’s behaviour concerning?

The first 24 hours are where small delays become big problems. A bright foal with good IgG and normal milestones is a beautiful start. A slow, weak, dull, non-nursing, or abnormal foal needs help quickly.

Early checks save foals. Guessing does not.

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If your foal is slow to stand, not nursing properly, has an abnormal IgG result, or you are unsure whether the first-day signs are normal, ASK A VET™ can help you work through the urgency and decide when veterinary care is needed.