Although an individual Shih Tzu's temperament varies from dog to dog, the breed has a personality and temperament that is loyal, affectionate, outgoing, and alert. Training and proper socializing must start at a young age for the Shih Tzu to obey basic commands, for the Shih Tzu is prone to stubbornness when it comes to training. While the Shih Tzu is an excellent watch dog because of its alert and active nature, it was not specifically bred for this purpose. Unlike the Lhasa Apso, which was bred to be a sentinel dog that enjoys high perches and is wary of strangers, the Shih Tzu prefers to be close to its companions and will often offer strangers its affection. Because of its friendly nature, the Shih Tzu tends to interact well with other dogs and with children and adults. [citation needed] Composer James Mumsford described the Shih Tzu as "... a dash of lion, several teaspoons of rabbit, a couple of ounces of domestic cat, one part court jester, a dash of ballerina, a pinch of old man, a bit of beggar, a tablespoon of monkey, one part baby seal, (and) a dash of teddy bear."

Like all breeds there may be some health issues, like hip dysplasia, patellar luxation and eye disease. Some dogs may be faced with these health challenges in their lives, but the majority of Shih Tzu are healthy dogs. Because of their heavy coats and short faces, Shih Tzu do not tolerate heat well and are not good swimmers. Shih Tzu puppies often bubble and snort while teething, but if this problem persists and is so severe that your dog is spending most of its time struggling for air, seek veterinary attention. When you travel with your pet, be sure to take along plenty of fresh water and frozen ice packs.

You must be careful to avoid eye injuries in a breed with large eyes and no muzzle to protect them, and seek prompt veterinary attention if you suspect an eye problem. One rare but serious health problem in this breed is juvenile renal dysplasia, in which the kidneys fail to develop normally. Working with a responsible breeder, those wishing to own a Shih Tzu can gain the education they need to know about specific health concerns within the breed. Good breeders utilize genetic testing of their breeding stock to reduce the likelihood of disease in their puppies.

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