Low-Stress Veterinary Visits for Avian Patients

Companion or “pet” birds present unique challenges as patients, and handling requires additional knowledge and unique skill sets for all veterinary team members. Of primary concern is the stress of the experience for each bird. Most birds arrive at the veterinarian’s office already in a state of distress, having been forced into the carrier, subjected to the foreign experience of traveling in a car, and being jostled while the carrier is transported.

Smaller passerines, such as finches and canaries, may be under additional stress due to poor diets and the fact that birds of these species are often kept as multiple individuals in a single cage. Typically, smaller birds like this are often seriously ill before owners notice.

Parrots (undomesticated prey animals living in captivity) are especially sensitive to increased acute stress. For more than 2 decades, the veterinary community has acknowledged that parrots are sensitive animals that can be injured physically and traumatized emotionally by rough or insensitive handling.¹ Excessive stress for a parrot during a hospital visit can result in a client who does not return, laboratory results that cannot be used, or worse.

Bird owners worry greatly about their birds’ stress levels during veterinary visits. Owner concerns result in a lack of preventive health care; most birds are seen only when sick. By committing to the goal of low-stress veterinary visits, veterinary team members can improve the quality of life and longevity of their avian patients.

How Does Stress Affect Birds?

Stress is the body’s physiological, behavioral, and psychological reaction to any change in the environment that is perceived as a threat. Stress has both immediate and long-term effects on physical and mental processes.²

The immediate stress response leads to increased heart and respiratory rates, increased blood glucose, and reduced cognitive ability.³ Acute stress may even lead to death in some patients with underlying conditions.

What Are the Benefits of Reducing Stress in Birds?

Reducing stress to the extent possible through sensitive handling of our avian patients is crucial. The benefits include improved patient care, increased accuracy of physical examination findings, and reduced injuries to veterinary staff and patients.^4,5 Reducing patient stress also results in exceptional client satisfaction, increased revenue, and greater team member morale.

What Makes Birds Unique Patients?

Birds present several challenges with regard to providing low-stress medical care. Bird personalities differ by species and individual, they can fly, and proper handling at home is often absent. Thus, veterinary team members handling the bird must be trained to do so in a safe and considerate manner.

Individuality

Exotic veterinary team members may see a large number of bird species. The parrot family alone comprises approximately 400 species. Moreover, each bird you see is an individual with a different personality and training history. What works for a single bird might not work for others.

Flight

Birds have the capacity for flight, sometimes even with clipped wings. It is becoming more common for owners to allow flight.

Training

It is uncommon for parrot owners to train their birds. Although some parrots readily take treats, others are often too stressed to eat or are unfamiliar with the concept of receiving a valued item in exchange for performing a requested behavior. It can be difficult for the veterinary team to find a way to interact with a parrot who is unfamiliar with this process.

Handling

Similarly, most owners lack handling skills and rely on force to get their bird into a carrier for the drive to the veterinary clinic. This experience often places the bird, unfamiliar with the force used and the experience of riding in car, over their “threshold” before the examination even begins. This use of “threshold” refers to an imaginary juncture at which the bird, previously calm, moves into a state of heightened arousal and reactivity.

Neophobia

Birds of most species display marked neophobic behavior—they are afraid of new things. In addition, most parrots lack socialization, never leaving their homes or seeing people who are not part of the family. Previous veterinary experiences may have created intense fear memories.

What Are the Signs of Stress in Birds?

Team members must learn to recognize and interpret avian signs of stress. A bird experiencing minimal stress willingly interacts with people, takes food items, explores the environment, and performs self-care behaviors like preening.

Mild

The first signs of stress include refusal to take treats or to engage socially. Early signs can also include an erect posture with feathers slicked tightly against the body or vocalizations. The bird may begin looking for signs of escape. For patients showing signs of mild stress, a good result can still be obtained by slowing everything down, especially the movements of team members. Allow the bird to drive the pace of handling. By slowing down movements, practitioners give patients the time they need to evaluate the situation. This slowdown also gives team members time to read and interpret body language.

Moderate

As stress builds, the bird will begin active attempts to escape; even birds with clipped wings will attempt to fly to escape a perceived stressful situation. The bird may exhibit stress defecation along with eye pinning and increased respiratory rate.

Severe

Switch immediately to a hands-off approach if any of the following signs are seen: aggression, panicked vocalizations, red tears in African greys, or open-mouthed breathing in the absence of any upper respiratory infection.

How Can We Minimize Stress in Birds?

Despite the challenges, making veterinary visits low stress for birds is absolutely possible and should be considered the standard of care. Achieving a low-stress visit takes the coordination of all veterinary team members; each person has a valuable role. The clients will also need to understand the value of this approach as it can often take extra time for each visit.⁶

Minimize Time in the Waiting Room

When clients arrive, a client service representative should greet clients and guide them to a quiet place with an elevated surface for the carrier. Placing birds on the ground causes stress as they typically seek height for safety. After check-in, the goal is to get them into an examination room. If not possible and the client must wait in the receiving area, the carrier should be covered to ensure calm. In a mixed-practice setting, the feline rather than canine receiving area is a better choice simply because cats are also likely to be in carriers; dogs on leashes may scare a bird even if trying to be friendly.

Make the Examination Room Feel Safe

The first responsibility for the veterinary nurse is to set up the examination room ahead of time. Birds are sensitive to changes in the environment and can exhibit extreme fear if items are moved around. For this reason, all instruments and materials to be used should be out on the counter already. An exception is that the towel to be used for restraint is best left out of sight until time for use as some birds associate towels with negative experiences. A laminated photo of the setup can be kept in a drawer to help staff members remember. Window coverings should be drawn as events happening outside can trigger a fear reaction. 

Remind the client to leave the bird in the carrier so that it can acclimate to the examination room in the safest way possible, eliminating risk for injury from possibly flying into windows or objects. The veterinary team member can perform a hands-off examination while taking a history and can then handle the patient in the safest manner. Information about removing the bird from the carrier is beyond the scope of this article, but helpful information is available elsewhere.⁶

The veterinary nurse’s role begins by observing the unrestrained bird in the examination room, which is a critical part of the physical examination. Health concerns can be identified and the bird’s temperament can be evaluated, including receptiveness to handling. During this time, the veterinary nurse can offer valued food or toy items, assessing the bird’s willingness to interact. If the bird exhibits signs of illness or weakness (e.g., open-mouthed breathing, hunched posture, dull mentation), handling should be minimized and the veterinarian should be consulted.

Team members should speak quietly and move slowly; with parrots, avoid prolonged eye contact, which some interpret as a challenge or threat. Remain attentive to the patient’s body language. If a parrot is talkative, it is best to not talk back to the bird as this behavior can trigger higher levels of arousal and aggression.

If possible, get the patient’s weight before beginning hands-on restraint, in a manner that creates the least amount of stress for the bird.  The scale should have a nonslip surface, and the bird should not be asked to perch in an uncomfortable position, such as with its tail hitting something. Position the scale so that the tail can hang off the edge. If the bird cannot be weighed without increasing stress, then save this step for later in the appointment so that the bird is only handled once. 

If Restraint Is Needed, Use a Towel

Team members providing restraint must be fully trained. Patient injuries and even death can result from unskilled or improper restraint. For example, placing pressure around the body of a bird can result in suffocation. Birds must be able to expand their keel bone in order to breathe normally.

Although some well-socialized birds might tolerate most if not all of the examination without restraint, restraint will be necessary for most. The best choice is use of a towel, which is usually tolerated well if used skillfully (FIGURE 1).

Figure 1. A Meyer’s parrot being restrained using a towel. Courtesy Kara M. Burns, MS, MEd, LVT, VTS (Nutrition)

The towel size and flexibility can be tailored to the individual bird. The towel will hold the wings against its body. The bird can chew on the towel for distraction (FIGURE 2), or the towel can be used to cover the eyes to reduce stress.

Figure 2. A parrot being allowed to chew the towel restraint for distraction. Courtesy Kara M. Burns, MS, MEd, LVT, VTS (Nutrition)

Getting the bird into the towel easily is the mark of the experienced avian veterinarian or veterinary nurse. Each veterinary team will create a best approach. There are several methods for using towels with birds in the least stressful manner. Describing these is not within the scope of this article; however, an excellent resource is LafeberVet (lafeber.com/vet).⁷ The website provides videos and a full discussion of ethical and behavioral aspects of restraint. After the best method for an individual bird is found, it should become a permanent part of the patient’s chart.

Limit towel restraint to the shortest time possible. For parrots, you can reduce struggling by offering them something to hold in their feet. Try a few tongue depressors or cotton swabs wrapped together with tape; the size can be adapted to the size of the bird. Birds of any species should be allowed to maintain a normal upright posture during the examination with wings held close to the body. Save the more intrusive aspects of any examination (e.g., coelomic palpation, cloacal examination) for last.

Sedate, if Necessary

For patients whose body language continues to indicate excessive, escalating stress, conscious sedation should be considered.⁶ The most common protocols involve giving midazolam either alone or in combination with butorphanol. The goal of conscious sedation is to have the patient standing but relaxed. Midazolam also has the advantage of being fully reversible.

Collaborate With Clients

The commitment to low-stress handling involves collaborating with clients. The low-stress visit begins when scheduling the new client. Let the client know what to expect, especially with regard to visit length. Avoid the need for clients to complete paperwork on the day of the visit by mailing it to them or having forms accessible online. Encourage the client to bring any of the patient’s favorite toys or treats with them.

At the end of the visit, the veterinary nurse can help the client develop a training plan for home to address behaviors that will make the subsequent visits easier. Clients can teach their bird many behaviors that will help with future veterinary visits.^8,9 These behaviors include stepping onto a scale, allowing restraint in a towel, and voluntarily assuming and holding postures for palpation. Client education will only be possible, however, if the veterinary team members understand the science of behavior change and how to use positive reinforcement to teach new behaviors. Veterinary team members who are well versed in behavior change are worth their weight in gold!

Keep Thorough Records

To make the next visit easier on everyone, all behavioral information should be entered into the patient’s record. Recorded information should include the patient’s flight ability, the client’s ability to handle the patient, how the patient reacted to the veterinary team, and the method of restraint used.

Summary

Low-stress visits for avian patients are possible and should become the standard of care. Achieving this goal takes the coordination of all team members. By understanding the many challenges that birds bring to the clinic experience, the team can prepare effectively and behave in such a manner that the bird’s stress levels remain as low as possible. If all of these actions are not enough to prevent the bird from going over their threshold, conscious sedation can be considered.