Choke in horses

Choke is an equine emergency that occurs when food or a foreign object gets lodged in the horse’s oesophagus (the muscular tube connecting the mouth to the stomach). This is different from when a person ‘chokes’ – in this situation, the person is unable to breathe because something (usually food) is lodged in their airway. In contrast, a horse with choke can breathe because the obstruction is in the oesophagus, so the condition is not immediately life-threatening. 

The most common cause of choke is a horse eating too quickly (i.e., “bolting” their feed). When horses eat too quickly, they do not chew enough, so the food does not soften and can form a firm lump (“bolus”) that can lodge in the oesophagus.  

Horses are more likely to bolt, and subsequently choke on, concentrated bucket feeds rather than forage such as hay or grass. However, if a horse has dental problems or abnormal anatomy that makes it difficult to properly chew and/or swallow forage, this can cause choke too. A horse may also choke on other food items such as apples, carrots, and crunchy treats. If a horse is allowed to eat too soon after sedation, they may be unable to chew properly and may choke as a result. Choke can also occur if the horse doesn’t drink enough water, particularly if also eating dry, pelleted feeds or other expanding feed such as dry sugar beet pulp.  

Signs of choke include: 

• Feed coming out of nostrils. This is often green and slimy in appearance and can be intermittent 
• Excessive drooling/saliva
• Coughing and retching
• A hard lump on the left side of the neck (the oesophagus is close to the bottom of the neck, not the top of the neck near the mane)
• Discomfort that can look like signs of colic 
• The horse may initially keep eating, despite the choke
• Horses cannot vomit so that is not a sign to look for

Choke is not immediately life-threatening, since the horse can still breathe, but it is important to contact a vet as soon as choke is suspected. The risk of complications, including oesophageal rupture, increases with delayed treatment. Choke can also lead to aspiration pneumonia, whereby food or water passes into the lungs and causes an infection. Aspiration pneumonia can take days to develop so even if a choke incident resolves quickly, it is still best to contact a vet as they may wish to put the horse on preventative antibiotics.  

If you suspect your horse is suffering from choke: 

• Remove any sources of food or water while waiting for the vet
• It can be helpful to walk and/or muzzle the horse to prevent them from eating, if turned out
• If an obstruction can be felt on the left side of the neck this can be gently massaged (if the horse will tolerate this)
• Do not administer oral medications while waiting for the vet
• Do not try to dislodge the blockage by inserting a hose or anything else down the horse’s throat. This is very likely to do more harm than good

The vet will probably sedate your horse to help relax the oesophageal muscles. They may administer intravenous fluids to maintain hydration while the horse resolves the choke on its own or may use a nasogastric tube to flush the blockage with water, softening it and encouraging it to pass.  

After the obstruction has been cleared it is important to monitor your horse for a few days because it is common for some food to pass through the trachea into the lungs, where it can cause secondary infections. It is a good idea to monitor your horse’s temperature, and alert the vet of any coughing, fever, nasal discharge, or difficulty breathing. The vet may advise to feed only soft, wet mashes for a few days to allow the oesophagus to recover.  

Risk factors and prevention

To prevent choke, provide routine dental care from a qualified professional to make sure the horse can chew properly. Senior horses are particularly vulnerable to choke and should receive dental care every six months. If their teeth no longer allow them to adequately chew hay or grass, ask your vet or nutritionist about providing soaked complete feeds instead.  

For all horses, make sure that expanding feeds such as sugar beet pulp are thoroughly soaked before feeding. Always feed hay before concentrate feeds or include a chaff/chopped forage in their feed bucket, so hungry horses do not bolt bucket feeds. Feeds can be dampened with water to aid passage down the oesophagus. It is preferable to ensure forage is available 24/7. Hay nets and other slow feed strategies can help extend feeding time, but where possible, forage and feed should be fed from the floor. Large, smooth rocks in buckets can slow down fast eaters. If horses are fed as a group, make sure there is adequate space between individuals to prevent competition, as this can lead to rapid eating. Consider separately feeding any horses who have their buckets taken by other horses.