Foaling is generally more difficult in miniatures than in full-size horses. The small size of the mare does not allow for much manipulation and the potential for malformations, especially of the head (above), neck and forelegs of the foal, can make deliveries challenging. Observation is crucial and some assistance is almost always needed. Veterinarians should be sure that their mini breeders are aware of and use some of the foaling monitoring systems and devices that are available. Experienced help should be on hand for the delivery, and a procedure for obtaining quick veterinary assistance should be discussed prior to the delivery date. Dystocias must be dealt with rapidly or unfortunate results are much more likely to occur.

It is very important, however, that veterinarians become educated about these potential patients because they are substantially different from full-size horses, and their care and management present unique challenges to the practitioner. Additionally, these small horses are attractive to first-time horse owners. Miniatures are popular with older clients and with clients who have reduced acreage but who want the equine experience. Many of these owners lack the husbandry skills needed to care for them. They are neither small horses nor large dogs but are commonly treated as such by many owners. Good knowledgeable veterinary care is critically needed for these clients.

Dwarfism or achondroplasia is believed to be an autosomal dominant condition that is commonly seen in some miniatures. Associated malformations can occur in the feet and legs, head and face or in the teeth and bones of the jaws.