I appreciate the comments by Drs Alexander and Smith. Their review of recommendations expands my article1 beyond its original scope and intent in a useful way.
While these recommendations are well recognized by those of us working in child abuse centers, they do remain guidelines. Referring a young sibling of an abused child who is not only asymptomatic but free of external signs of abuse and without a direct history of shaking may represent a more difficult decision than the guidelines indicate when access to specialty care, MRI, etc is not immediately at hand.
Hansen KK. Investigating Abuse in the Asymptomatic Twin-Reply. Arch Pediatr Adolesc Med. 1996;150(4):445. doi:10.1001/archpedi.1996.02170290110026
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