First Tooth Eruption Does Not Predict When Infants Start Walking Independently

A cross-sectional investigation conducted by researcher Mahmoud Usama and published in the Bulletin of Faculty of Physical Therapy demonstrates that the timing of a child’s first primary tooth eruption shares no statistically significant association with the onset of independent walking in healthy pediatric populations. Examining two hundred six healthy children aged twelve to sixty months in Cairo and Giza, the study evaluated whether deciduous dental emergence predicts or correlates with independent locomotor milestones. In clinical consultations, parents frequently worry that late teething might foreshadow delayed motor progress, or that early walking reflects accelerated dental maturity. However, empirical testing revealed a correlation coefficient of r equals 0.045 with a non-significant p-value of 0.523 between these developmental events. These findings confirm that primary tooth eruption and unaided walking operate as completely independent biological processes, showing that neither milestone serves as an indicator for the timing of the other.

Developmental milestones represent critical indicators of physical growth and maturation, yet both primary dentition and gross motor milestones display broad normal variation across children and populations. Under standard conditions, a child’s first primary tooth typically erupts between four and ten months of age, with a mean timing of roughly six to seven months. In comparison, independent walking is generally achieved between nine and eighteen months, showing a population average around twelve to thirteen months. Both achievements carry deep emotional and clinical meaning for families and pediatricians because they mirror general health and developmental progression. Tooth mineralization follows a predictable biological sequence, allowing clinicians to utilize dental maturation alongside skeletal development, weight, and height to appraise physiological age and detect potential growth disturbances. Concurrently, independent walking serves as a cornerstone of gross motor progress, facilitating physical exploration, personal autonomy, and social engagement within healthy early childhood development.

To resolve whether a direct temporal connection exists between dental and locomotor milestones, the study enrolled two hundred six healthy children between March 2024 and February 2026. Ethical approval was formally granted by the Cairo University Faculty of Physical Therapy Ethical Committee under reference number P.T.REC/012/006205, adhering strictly to the Declaration of Helsinki. Sample size planning was executed using G*Power software version 3.1.9.2, based on a two-tailed correlation test with an alpha of 0.05 and a statistical power of 0.80. A pilot investigation involving twenty healthy children excluded from the final cohort suggested a moderate correlation effect size of rho equals 0.33, establishing a minimum requirement of ninety participants. The study sample comprised ninety-five girls and one hundred eleven boys with an average age of 29.79 months. Within this group, 96.1 percent were born between thirty-seven and forty-one weeks of gestation, 74.3 percent were delivered by Cesarean section, and 59.7 percent of families reported high socioeconomic status.

Strict eligibility criteria were maintained to separate normal physiological variation from clinical pathologies that impair development. Premature infants born prior to thirty-seven gestational weeks, twins, and syndromic children were systematically excluded. The protocol likewise disqualified children with neuromuscular diseases such as cerebral palsy, spinal muscular atrophy, or muscular dystrophy, alongside those diagnosed with chronic illnesses including asthma, pediatric hypertension, diabetes mellitus, cardiovascular anomalies, endocrine diseases, metabolic disorders, and systemic inflammatory diseases. Because disorders like rickets, hypothyroidism, and malnutrition independently delay both dental eruption and motor milestones, omitting these conditions ensured that the analysis addressed healthy development rather than underlying systemic illness. Furthermore, participants underwent screening for abnormal anthropometric percentiles, and a pediatric dentist conducted oral physical examinations on every enrolled child to rule out local gingival or oral pathologies, including natal teeth, gingival cysts, and congenital epulis. From two hundred twenty-one initial candidates, fifteen were excluded due to parental choice or maternal recall limitations.

Data collection was executed through a structured, three-part questionnaire administered during maternal interviews by four trained medical students who, alongside participating parents, remained completely blinded to the precise research hypothesis. The questionnaire followed a multi-stage development protocol: initial literature synthesis, drafting by two pediatricians and an epidemiologist, face validity review by five expert pediatricians, and pilot testing on twenty mothers. Content validity was verified by Item-Content Validity Index scores between 0.85 and 1.00, and test-retest reliability across fifteen mothers evaluated two weeks apart yielded an intraclass correlation coefficient of 0.92 for milestone recall. The instrument’s first section recorded demographic parameters, delivery route, and parental recall of tooth eruption and independent walking. The second section documented feeding patterns and nutritional supplements during the first twelve months of life. The third section extracted objective anthropometric measurements taken at the time of independent walking from medical records, enabling researchers to compute body mass index and percentile rankings.

Data analysis performed using SPSS software version 19.0 evaluated multiple nutritional, biological, and perinatal variables to determine whether external influences altered the timing of dental emergence. In this sample, the mean age for first tooth eruption was 6.86 months, spanning a range from 3.00 to 13.00 months. Maternal breastfeeding averaged 12.91 months, but bivariate analysis revealed no significant association with tooth eruption timing, yielding r equals -0.003 and p equals 0.964 in the total sample, and r equals -0.014 with p equals 0.894 among exclusively breastfed infants. Nutritional supplementation between birth and twelve months similarly displayed no meaningful association with dental timing. Children receiving vitamin D prophylaxis showed an average eruption age of 6.98 months compared to 6.32 months among untreated peers, showing no significant difference at p equals 0.061. Multivitamin supplementation likewise failed to alter eruption schedules at p equals 0.56, while iron prophylaxis showed no relationship at p equals 0.147.

Parallel examinations into independent walking revealed an average achievement age of 12.58 months, with observed times ranging from 8.50 to 24.00 months. Independent walking timing was unrelated to breastfeeding duration, yielding a Spearman rho of 0.042 and p equals 0.554. Prophylactic vitamin D, multivitamin usage, and iron prophylaxis likewise showed no statistical relationship with walking onset, registering p-values of 0.685, 0.965, and 0.742, respectively. Neither birth weight nor birth height correlated with walking age, demonstrating rho values of -0.062 and -0.033. At the time of independent walking, the children presented a mean height of 76.10 centimeters and a mean body mass index of 16.69. Stratification into body mass index categories indicated that 68.93 percent were normal weight, 14.08 percent were obese, 12.14 percent were overweight, and 4.85 percent were underweight; a Kruskal-Wallis test showed no difference in walking onset across these weight groups at p equals 0.893. Furthermore, seventy-seven children utilized mechanical infant walkers, yet their walking achievement did not differ significantly from non-users at p equals 0.069.

When comparing the two milestones directly, the researchers observed a complete lack of statistical correlation. The Spearman rank correlation between age at first tooth eruption and age at independent walking was rho equals 0.045 with a p-value of 0.523 across the cohort. Child sex exerted no significant effect on milestone timing, with boys and girls achieving walking at comparable ages at p equals 0.758 and experiencing first tooth emergence at comparable ages at p equals 0.802. Individual milestone sequences varied: five children achieved walking and teething concurrently, six walked before teething, and one hundred ninety-five teethed prior to walking, displaying an average interval of 6.07 months. Stepwise multivariate linear regression models confirmed these findings. For tooth eruption, entering vitamin D, iron, and sex yielded no significant predictors, with an adjusted R-squared of 0.008 and p equals 0.312. For independent walking, entering walker usage and breastfeeding duration produced no significant predictors, yielding an adjusted R-squared of 0.012 and p equals 0.245.

The biological rationale underpinning this independence reflects the distinct physiological mechanisms governing dental and gross motor development. Primary tooth eruption is regulated by localized biological processes in the alveolar bone and periodontal ligament, including the creation of an eruption pathway, resorption of overlying bone, and activity among dental follicle cells. These cellular events are predominantly guided by genetic programming and systemic endocrine factors, such as thyroid and growth hormones. Conversely, independent walking requires advanced central nervous system maturation involving the corticospinal tract, basal ganglia, and cerebellum, coupled with the progressive attainment of postural control, dynamic balance, and anti-gravity muscle strength. Because dental emergence and motor coordination operate along separate biological tracks, progress in one system does not signal advancement in the other. This biological divergence is reinforced by international evidence: a multicenter study in Brazil observed wide variability without temporal synchronization, while a longitudinal investigation from China revealed that early motor milestones do not predict primary tooth eruption schedules.

From a clinical standpoint, these findings provide vital evidence-based reassurance for healthcare providers and parents, demonstrating that isolated milestone variations within standard physiological ranges represent normal development. Independent walking is clinically considered delayed only if unachieved by eighteen months, while typical teething spans from four to ten months; variations within these intervals are benign and do not require specialist intervention. Pediatricians, physical therapists, and dentists can advise parents that late teething does not predict delayed walking, nor does early walking accelerate tooth eruption. When assessing an otherwise healthy child who walks later than peers, clinicians should not view teething history as a prognostic marker, nor should delayed dentition trigger developmental referrals. Several study limitations were noted, including the regional Egyptian cohort, reliance on maternal recall within a cross-sectional framework, non-standardized subjective socioeconomic measures, and incomplete maternal dietary assessments during pregnancy. The authors recommended future prospective investigations tracking diverse cohorts from birth, incorporating validated socioeconomic indices like Hollingshead or Kuppuswamy scales, and exploring genetic polymorphisms in MSX1, PAX9, or HOX genes.

Subject of Research: Relationship between primary tooth eruption and independent walking onset in healthy children

Article Title: Early childhood milestones: investigating the relationship between first tooth eruption and independent walking

Article References: Usama, M. (2026). Early childhood milestones: investigating the relationship between first tooth eruption and independent walking. Bulletin of Faculty of Physical Therapy, 31(1), Article 24. https://doi.org/10.1186/s43161-026-00360-z

Image Credits: AI Generated

DOI: 10.1186/s43161-026-00360-z

Keywords: child development, developmental milestones, tooth eruption, independent walking, pediatric health, gross motor development, primary dentition, infant development, Early, childhood, milestones, investigating