Publication Date



Open access

Degree Type


Degree Name

Doctor of Philosophy (PHD)


Nursing (Nursing)

Date of Defense


First Committee Member

Gail McCain - Committee Chair

Second Committee Member

Elias P Vasquez - Committee Member

Third Committee Member

Barbara Luke - Committee Member

Fourth Committee Member

Walter Lambert - Committee Member


Maltreatment affected an estimated 794,000 children in the 50 States, the District of Columbia, and Puerto Rico in 2007 (United States Department of Health and Human Services [USDHHS], 2009). The purpose of this study was to examine the risk factors of young maternal age, parents' marital status, multiple birth, preterm birth, birth defects/disability, low economic status, and parental substance abuse related to suspected maltreatment of children 3 years of age or younger from the prospective of pediatric nurse practitioners (PNPs). A cross-sectional survey design, using the Tailored Design Method, was used in this study. A convenience sample consisting of the National Association of Pediatric Nurse Practitioners (NAPNAP) email registry was used for this study with a response rate of 11%. The respondents represented all regions of the United States. Seventy-nine percent of the PNP's (n=363) who completed the survey had suspected child abuse or neglect within the last year in a child three years of age or younger compared to 21% of PNPs (n=96) who did not suspect child maltreatment within the past year. The prevalence of suspected child maltreatment in the study population was 2.35%. According to the model examining child risk factors and abuse, the log of the odds of a child being abused was negatively related to preterm birth (p = .036) and birth defects/disability (p = .001). Multiple birth was positively related but not significant (p = .359). There were no statistically significant child risk factors found in the logistical regression for neglect (preterm birth, p = .180; multiple births, p = .938; birth defects/disabilities, p = .234). When examining the abuse and neglect groups together, the log of the odds of a child being abused and neglected was negatively related to birth defects/disabilities (p = .030). Preterm birth (p = .364) and multiple birth (p = .298) were positively related to the abuse and neglect group but were not significant. According to the model examining parental risk factors and abuse, the log of the odds of a child being abused due to a parent characteristic was negatively related to low economic status, with the proxy being WIC eligibility (p = .001) and a history of substance abuse (p = .031). The regression for abuse indicated a positive, yet insignificant, relationship with young maternal age (p = .129) and single marital status (p = .816). The logistic regression for neglect indicated a positive significant relationship with a substance abuse history (p = .012). The regression for neglect indicated positive but insignificant relationships for young maternal age (p = .693), marital status (p = .343), and WIC eligibility (p = .106). There were no statistically significant parental risk factors found in the logistical regression for abuse and neglect together (young maternal age, p = .263; marital status, p = .523; WIC eligibility, p = .131; substance abuse, p = .985). Findings indicated that child maltreatment is suspected by PNPs in primary care settings, and that PNPs recognize signs and symptoms of abuse and neglect.


Child Maltreatment; Child Abuse; Nurse Practitioners; Logistic Regression; Tailored Design