A nurse is caring for a group of children in a clinic. Which of the following children should the nurse identify as being at an increased risk for child maltreatment?

Choice A reason: A preschooler who frequently says “no” is demonstrating a normal developmental behavior. This stage, often referred to as the “autonomy versus shame and doubt” phase, is characterized by oppositional responses as the child learns independence. While this behavior may be frustrating for parents, it is not a significant risk factor for maltreatment in itself. Most parents recognize this as typical and adjust their expectations accordingly. Choice B reason: A school-age child whose parent has generalized anxiety disorder may experience some challenges related to parental stress or inconsistent emotional availability. However, generalized anxiety disorder does not inherently predispose a parent to abusive or neglectful behavior. Parents with anxiety may be overly protective or cautious, but this does not equate to an increased risk of maltreatment compared to conditions that involve significant functional impairment or stressors. Choice C reason: An adolescent requesting contraception is exercising autonomy and responsibility in managing reproductive health. While this may cause conflict in families with strict cultural or religious beliefs, it is not a direct risk factor for maltreatment. Adolescents seeking contraception are more likely to face judgment or lack of support, but this does not equate to the same level of risk as children with chronic disabilities who require extensive care. Choice D reason: A toddler with cerebral palsy is at the greatest risk of child maltreatment. Children with chronic physical disabilities often require significant caregiving, which can place stress on families. The increased dependency, frequent medical needs, and potential behavioral challenges associated with cerebral palsy can overwhelm caregivers, especially if resources or support systems are limited. Research consistently shows that children with disabilities are at higher risk for neglect and abuse compared to their peers without disabilities. This makes this option the most appropriate answer.