Bottle Jaw Without Anemia: When the FAMACHA Lies
By a goatkeeper who’s been fooled more than once
You walk out to check your goats and see it: swelling under the jaw. Your heart sinks. Worms. Again.
But then you check the FAMACHA score, and it’s… good? Pink eyelids, no pallor. How can a goat have bottle jaw without anemia?
I’ve been there—confused, worried, and watching goats decline while the standard indicators said everything was fine. Over years of herd losses (including a devastating first year that cut our herd from 34 to 19), I’ve learned that head swelling in goats is a puzzle with many pieces.
This guide will help you sort through them.
First: Is It REALLY Bottle Jaw?
Before we dive into causes, let’s be sure we’re talking about the same thing.
True bottle jaw (submandibular edema) is:
- Soft and pitting — your finger leaves a dent that remains for a few seconds
- Located directly under the jaw, in the soft tissue between the jawbones (intermandibular space)
- Fluid, not solid tissue — it feels like a water balloon, not a potato
- Usually develops gradually over days to weeks
If what you’re seeing doesn’t match this description, you’re likely dealing with something else entirely—an abscess, cyst, hematoma, or tumor. We’ll cover those too.
Why Bottle Jaw Happens (The Quick Version)
Bottle jaw is edema—fluid accumulating in the tissues under the jaw. This happens when:
- Blood protein (albumin) drops too low
- Albumin normally acts like a sponge, holding fluid inside blood vessels
- Without enough albumin, fluid leaks out into surrounding tissues
- Gravity pulls it to the lowest point → under the jaw
In barber pole worm infections, blood loss causes protein loss → bottle jaw WITH anemia.
But when FAMACHA is good, the protein loss is coming from somewhere else.
SCENARIO 1: True Bottle Jaw with Good FAMACHA
If you have soft, pitting edema under the jaw but the FAMACHA score is good (1-2), you’re looking at a protein loss problem, not a blood loss problem. Here are the possibilities:
| Cause | What Happens | Key Distinguishing Features |
|---|---|---|
| Brown Stomach Worm (Teladorsagia circumcincta) | This worm doesn’t cause significant anemia like barber pole, but damages the gut lining leading to protein loss | Often occurs in cooler months (fall/winter/spring); may see diarrhea and weight loss without pale membranes; responds to deworming but may need different class than barber pole |
| Liver Fluke (Fasciola hepatica) | Damages liver tissue → interferes with protein production (albumin) → fluid accumulates | Regional (Pacific NW, Gulf Coast, wet low-lying areas); chronic weight loss; may have rough coat; requires specific fluke treatment |
| Johne’s Disease (Mycobacterium avium paratuberculosis) | Chronic intestinal infection prevents protein absorption | Progressive weight loss despite good appetite; intermittent or persistent diarrhea; unresponsive to deworming; usually multiple years in herd |
| Caseous Lymphadenitis (CL) — Internal form | Internal abscesses disrupt protein metabolism | External abscesses may or may not be present; chronic wasting; hard to diagnose without ultrasound |
| Copper Deficiency | Interferes with both blood cell production AND protein metabolism | Faded or rough hair coat (bleached appearance); poor growth; musculoskeletal issues; “fishhook” ribs; responds to copper supplementation |
| Nutritional Protein Deficiency | Simply not enough protein in the diet to maintain blood albumin levels | Multiple goats affected; emaciation despite adequate calories; dramatic improvement with better protein (alfalfa, BOSS, soybean meal) |
| Chronic Kidney Disease | Protein lost through urine | Increased thirst/urination; older goats; requires bloodwork to diagnose |
A Note on Protein Deficiency
When I look back at some of our losses during that first year of bad hay and sweet feed, I now recognize that protein deficiency played a role. The goats were getting calories but not quality protein. Their bodies couldn’t maintain albumin levels, and fluid started leaking into tissues—including under the jaw.
The fix wasn’t deworming. It was better nutrition: alfalfa, black oil sunflower seeds, and eventually going completely grain-free.
SCENARIO 2: Other Types of Jaw Swelling (Not Bottle Jaw)
This is where your fingers become your best diagnostic tool. Not every lump under the jaw is bottle jaw.
Research on 166 sheep and goats with superficial swellings found that head swellings (56 cases) had multiple causes :
| Type of Swelling | % of Cases | How to Tell the Difference |
|---|---|---|
| Abscesses | 32.5% | Firm or fluctuant (moves like a fluid-filled balloon); may be painful; often from C. pseudotuberculosis (CL) |
| Hernias | 34.3% | Usually abdominal, not typically under jaw—included for completeness |
| Hematomas | 8.4% | From trauma; feels like a fluid-filled sac; often on ears or head; may change over days |
| Cysts | 7.2% | Including wattle cysts in goats (breed-related, present from birth, harmless) |
| Tumors | 14.5% | Firm, growing mass; various locations; may be attached to underlying tissue |
| Urethral diverticula | 3.0% | Penile area only—not relevant here |
For head swellings specifically, the breakdown was:
- Abscesses: 37 of 56 head swellings (15 acute, 22 chronic)
- Hematomas: 14 of 56 (many on head/ears)
- Tumors: 5 on head
Common Specific Causes of Jaw/Head Swelling
| Condition | Description | How to Identify |
|---|---|---|
| Caseous Lymphadenitis (CL) | Bacterial abscess of lymph nodes under jaw | Firm to fluctuant; may rupture with thick, layered pus (like toothpaste); other goats affected; slow-growing |
| Actinobacillosis (“Wooden Tongue”) | Bacterial infection of soft tissues | Hard swelling of tongue and jaw; drooling; difficulty eating; tongue feels firm (“wooden”) |
| Lumpy Jaw (Actinomycosis) | Bone infection | Hard, bony swelling attached to the jawbone itself; usually one side only; may have draining tracts |
| Salivary Mucocele | Ruptured salivary duct leaks saliva | Soft, fluctuant swelling under jaw or cheek; not painful; may fluctuate in size |
| Wattle Cysts | Congenital fluid-filled sacs | Soft, fluid-filled; present from birth; breed-related (Nubians, Boers, their crosses); harmless |
| Insect Bites/Stings | Allergic reaction | Sudden onset (hours); may see sting site; warm; resolves with time and antihistamines |
| Trauma/Hematoma | Blood collection from injury | History of fighting, hitting head on feeder, or other injury; may be painful initially; can feel fluctuant |
| Snake Bite | Venom reaction | Rapid swelling; possible fang marks; systemic signs (lethargy, difficulty breathing, drooling) |
How to Tell the Difference: Your Field Guide
| Feature | True Bottle Jaw | Abscess | Cyst | Hematoma | Tumor |
|---|---|---|---|---|---|
| Texture | Soft, pitting (finger leaves dent) | Firm to soft center; may feel like a balloon | Fluid-filled, smooth, well-defined | Spongy at first, then firmer as it organizes | Hard, fixed, may be irregular |
| Location | Directly under jaw, midline | Anywhere, often near lymph nodes | Often on neck or wattles | Often on ears or head | Anywhere |
| Onset | Gradual (weeks) | Gradual | Present from birth | Sudden (after trauma) | Gradual (weeks to months) |
| Pain | None | May be tender, especially if acute | None | Initially painful | Usually none unless pressing on nerves |
| FAMACHA | May be good or poor | Good | Good | Good | Good |
| Other Signs | Signs of protein loss: weight loss, poor coat, diarrhea possible | Possible fever; other abscesses; eventual rupture with pus | None | History of injury; bruising possible | Weight loss possible with malignancy |
| Aspiration | Fluid (transudate) | Thick pus (white/green, layered) | Clear, watery fluid | Blood or blood-tinged fluid | Usually solid; little aspirated |
Your Practical Action Plan
When you see jaw swelling with good FAMACHA, here’s how to work through it:
Step 1: Palpate Thoroughly
This is your most important step. Spend real time feeling the swelling.
- Is it soft and pitting? Push your finger into it for 5-10 seconds. Does it leave a dent? → True bottle jaw
- Is it firm but movable? Can you push it around? → Possible abscess or cyst
- Is it rock hard and attached to bone? → Possible lumpy jaw or tumor
- Does it feel like a water balloon? → Possible abscess or cyst
Step 2: Check the Rest of the Five Point Check
- Back: Body condition score (1-5). Thin? → Protein loss likely
- Tail: Diarrhea or scours? → Johne’s, brown stomach worm, or gut infection
- Nose: Discharge? → Possible abscess draining
- Hair coat: Rough, dull, faded? → Copper deficiency possible
Step 3: Consider Aspiration (with Vet Guidance)
A simple needle stick can tell you volumes:
- Pus (thick, white/green, layered) → CL abscess
- Clear fluid → Cyst or salivary mucocele
- Blood or pink fluid → Hematoma
- Nothing comes out → Solid mass (tumor) or bone involvement
Step 4: Think Regionally and Seasonally
- Are liver flukes a concern in your area? (Wet, low-lying pastures)
- Is it cool weather? Brown stomach worm season
- Have you had Johne’s on the farm before?
Step 5: Review Nutrition
- Is protein intake adequate? (Hay quality, access to alfalfa, BOSS, etc.)
- Are minerals balanced? Copper deficiency is real and mimics other conditions
- Have you changed feed recently?
Step 6: Watch for Progression
- True bottle jaw should improve within 1-2 weeks of addressing the underlying protein loss
- Abscesses will eventually point and rupture (usually 2-4 weeks)
- Tumors will slowly grow
- Cysts stay about the same size indefinitely
Step 7: Consult Your Vet
Ultrasound can differentiate these with 80-100% accuracy. It’s the best tool for definitively identifying the type of swelling when you’re unsure.
Bloodwork can check:
- Albumin levels (low in protein loss)
- Liver enzymes (elevated in fluke damage)
- Copper status
When to Worry (Red Flags)
While bottle jaw with good FAMACHA is rarely an emergency, these signs warrant immediate attention:
| Red Flag | What It Might Mean |
|---|---|
| Difficulty breathing | Swelling pressing on airway—emergency |
| Difficulty eating | Pain or mechanical obstruction |
| Rapid progression (hours to days) | Infection, snake bite, or allergic reaction |
| Fever | Active infection |
| Neurological signs | Something more serious (enterotoxemia, polio) |
| Multiple goats affected | Nutritional deficiency, liver fluke, or contagious disease |
Treatment Approaches by Cause
| Cause | Treatment | Expected Timeline |
|---|---|---|
| Brown Stomach Worm | Deworm with appropriate class (levamisole, moxidectin, or benzimidazole—check resistance) | Improvement in 1-2 weeks |
| Liver Fluke | Specific flukicide (clorsulon, albendazole high dose) | Gradual over weeks |
| Johne’s Disease | No cure; supportive care; isolate from herd | Progressive decline |
| Copper Deficiency | Copper boluses or injection (with vet guidance); improve mineral program | Improvement over weeks to months |
| Nutritional Protein Deficiency | Increase protein: alfalfa, BOSS, soybean meal, high-quality hay | Noticeable improvement in 1-2 weeks |
| CL Abscess | Drain and flush (isolate from herd); some vets treat systemically | Heals after drainage; may recur |
| Cyst | Leave alone unless problematic; surgical removal if needed | Stable |
| Hematoma | Time; cold packs initially; warm compresses later | Resolves over days to weeks |
| Tumor | Surgical removal if possible and benign; prognosis varies | Progressive |
Bottom Line
Bottle jaw with good FAMACHA means the problem isn’t blood loss—it’s protein loss from somewhere else. The usual suspects are:
- Brown stomach worm (especially in cool weather)
- Liver fluke (if you’re in a wet, fluke-prone area)
- Johne’s disease (chronic wasting, unresponsive to treatment)
- Copper deficiency (faded coats, poor growth)
- Simple malnutrition (not enough protein in the diet)
Other jaw swellings with good FAMACHA are usually abscesses (CL), cysts, hematomas, or tumors. Your fingers, not your eyes, will tell you which.
The key is palpation:
- Pitting edema = true bottle jaw = look for protein loss
- Firm mass = something else = investigate locally
About the Author
I’m a goatkeeper who learned most of this the hard way—through losses. Our herd went from 34 to 19 in a brutal first year in Virginia, thanks to bad hay, sweet feed, and a cascade of health problems we didn’t understand at the time. The goats that survived are survivors in every sense. The ones we lost taught me to look closer, question assumptions, and trust my hands more than my eyes.
If this helps even one goatkeeper catch something earlier, it’s worth writing down.
Have you seen bottle jaw with a good FAMACHA in your herd? What was the cause? Share your experience in the comments—we all learn together.