Background and purpose <p>Missed nursing care (MNC) are omissions that compromise patient care quality and are harder to detect than errors, posing greater risks to patient safety. However, current scales lack a cohesive framework, limiting the modelled association analysis between MNCs and self-reported causes. This study aims to classify MNCs, explore their relationships with self-reported causes, and examine the influence of sociodemographic factors among pediatric nurses.</p> Methods <p>A total of 459 pediatric nurses from 24 hospitals completed the Chinese-translated MISSCARE Survey-Ped. Exploratory factor analysis classified the MNCs, whose path analysis was subsequently performed based on self-reported causes. Sociodemographic factors were then analyzed to identify independent predictors across MNC quartile groups.</p> Results <p>The occurrence of pediatric MNCs was 67.7%, and the causes related to labor resources, material resources, and communication were reported at rates of 86.6%, 70.5%, and 72.0% respectively. Parallel analysis suggested a two-factor solution, which was subsequently extracted via EFA, classifying 28 MNCs into two distinct clusters in the Rotated Factor Space plot based on loadings &gt; 0.4, characterized as Timely and Behavioral MNCs, respectively. Based on the two principal categories, a satisfactory path model was developed (CFI = 0.997, TLI = 0.979, RMSEA = 0.058, SRMR = 0.062). In this model, self-reported causes showed a positive overall effect on MNCs (Standardized-beta[95%CI] = 0.201[0.091, 0.311], <i>P</i> &lt; 0.001). Negative effects were observed in path of labor resources → material resources (Standardized-beta[95%CI]=-0.578[-0.386, -0.770], <i>P</i> &lt; 0.001), communication → labor resources (Standardized-beta[95%CI]=-0.120[-0.046, -0.194], <i>P</i> &lt; 0.001), and communication → material resources (Standardized-beta[95%CI]=-0.856[-0.827, -0.885], <i>P</i> &lt; 0.001). Additionally, Timely and Behavioral MNCs exhibited opposing mutual effects (Standardized-beta[95%CI]=-0.361[-0.216, -0.506] and 0.807[0.787, 0.827], both <i>P</i> &lt; 0.001). Multivariate logistic regression revealed that factors such as communication, labor and material resources, position, education, fertility status, and hospital grade were independently linked to mild to severe MNC groups, with some showing negative correlations (OR = 0.433 ~ 0.525, all <i>P</i> &lt; 0.05), and others positive correlations (OR = 1.068 ~ 1.799, all <i>P</i> &lt; 0.05).</p> Conclusions <p>This study proposes a classification that divides MNCs into two categories, quantifies the modelled associations between MNCs and self-reported causes, and identifies independent factors that influence MNCs, offering evidence for effective interventions.</p> Implications for nursing management <p>Our innovative category of MNC behaviors supports path analysis and reveals the underlying modelled associations between MNCs and self-reported causes. As MNC severity increases, influencing factors follow a progression: individual factors → resource constraints → communication failure, offering insights for effective interventions.</p> Trial registration <p>National Universal Health Security Information Platform of National Health Commission (Registration No.: MR-51-25-037671, Date: Feb. 24, 2025).</p>