Publication Date



Open access

Degree Type


Degree Name

Doctor of Philosophy (PHD)


Nursing (Nursing)

Date of Defense


First Committee Member

Gail McCain

Second Committee Member

Elias P. Vasquez

Third Committee Member

Barbara Luke

Fourth Committee Member

Walter Lambert


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