||Inherent within a child protection investigator's overarching role of determining who needs protection is the responsibility to also ensure that preverbal children who have not experienced sexual abuse do not grow up thinking they have. Currently, there is a scarcity of research related to the confirmation of sexual abuse of children with limited verbal skills. This scarcity of research is concerning since investigations involving sexual abuse of preverbal children often have inherent complexities that make drawing conclusions difficult. The purposes of this dissertation research were to 1) identify predictors of child protection services accepting cases for investigation involving sexual abuse concerns of children less than 3 years old; 2) identify predictors of substantiation of cases investigated by child protection services; and 3) examine the concordance rate of anogenital examination findings between general medical providers conducting sexual abuse exams of preverbal children and medical providers who specialize in conducting pediatric sexual abuse exams, in order to aid investigative and medical professionals in their decision-making processes. Finally, this research sought to add to the literature by examining descriptive data related to demographic information, characteristics of alleged sexual offenders, nonspecific physical exam findings, behavioral symptoms, and the nature and range of concerns that prompted referrals of children less than 3 years old for sexual abuse evaluations. This exploratory quantitative study involved chart reviews of 183 children whose ages ranged from 1-month-old to 2 years and 11 months and who were examined for concerns of sexual abuse between 1999 and 2007 within a Tennessee metropolitan city. Binary logistic regression revealed that 1) "verbal indication" was the only significant factor for the Department of Children's Services accepting child sexual abuse reports of children less than 3 years old for investigations; 2) "having a witness" was a significant factor for child protective investigators to substantiate sexual abuse; and 3) being a juvenile sexual offender also significantly predicted substantiation of sexual abuse. Examination of agreement between the physical exam findings reported by general medical providers and those reported by forensic exam specialists based on percentage revealed a high disagreement ratio related to anogenital examinations.