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Investigating Abuse in the Asymptomatic Twin

Randell C. Alexander, MD, PhD; Wilbur L. Smith, MD
Arch Pediatr Adolesc Med. 1996;150(4):444-445. doi:10.1001/archpedi.1996.02170290110025.
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Shaken baby syndrome has been described as sometimes affecting more than one child in a family.1 In her recently described case of twins with simultaneous findings of shaken baby syndrome, Hansen2 has demonstrated the importance of actively seeking possible injuries in an asymptomatic sibling. In addition, she raised a number of questions about the approach to evaluation in such cases. Some of these questions have been addressed elsewhere,3,4 but they clearly bear repeating.

Regarding skeletal surveys to rule out occult abuse, Hansen suggests that it is advisable that they be obtained for asymptomatic children younger than 1 year. However, a more common recommendation is to obtain such surveys whenever the child is younger than 2 years.5 Beyond this age, the combination of infrequency of occult abuse-related fractures and the improved ability to detect such injuries through history and physical examination significantly lowers the value of such


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