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Children with special health care needs (CSHCN) experience various developmental challenges including difficulties in social relationships with peers. Using data from the Centers for Disease Control and Prevention's National Survey of Children with Special Health Care Needs 2009–2010, this correlational study examined predictors of difficulty making and keeping friends among CSHCN. Binary logistic regression was used to analyze the data. Findings indicate statistical significance for 12 out of 14 predictor variables. Key findings indicate the odds of having difficulty making and keeping friends are 3.06 times higher for children with an autism spectrum diagnosis and 2.87 times higher for children with some behavior problem when compared to other CSHCN. Overall, the logistic regression model classified 80.7% of the cases correctly. A secondary analysis also identified factors which significantly differentiate between CSHCN who have a lot of difficulty compared to a little difficulty making and keeping friends. For this analysis, eight variables were statistically significant.Children with special health care needs face challenges making and keeping friends.Twelve statistically significant predictor variables exist to assist health care practitioners implement more appropriate and sustainable interventions.Health care professionals informed by this research empower families to advocate for services.Partnering with families, health care professionals aid children with special health care needs make and keep friends.