title: Maltreatment in multiple-birth children.
abstract: OBJECTIVE
  The rate of multiple births has increased over the last two decades. In 1982, an increased frequency of injuries among this patient population was noted, but few studies have evaluated the increased incidence of maltreatment in twins. The study aim was to evaluate the features of all multiple-birth children with substantiated physical abuse and/or neglect over a four-year period at a major children's hospital.
  
  
  METHODS
  A Retrospective chart review was conducted of multiple-gestation children in which at least one child in the multiple set experienced child maltreatment from January 2006 to December 2009. Data regarding the child, injuries, family, and perpetrators were abstracted. We evaluated whether family and child characteristics were associated with maltreatment, and whether types of injuries were similar within multiple sets. For comparison, data from the same time period for single-birth maltreated children also were abstracted, including child age, gestational age at birth, and injury type.
  
  
  RESULTS
  There were 19 sets of multiple births in which at least one child had abusive injuries and/or neglect. In 10 of 19 sets (53%), all multiples were found to have a form of maltreatment, and all children in these multiple sets shared at least one injury type. Parents lived together in 63% of cases. Fathers and mothers were the alleged perpetrator in 42% of the cases. Multiple-gestation-birth maltreated children were significantly more likely than single-birth maltreated children to have abdominal trauma (13% vs. 1%, respectively; p<.01), fractures (83% vs. 39%; p<.01), and to be injured at a younger mean age (12.8 months vs. 34.8 months; p<.01).
  
  
  CONCLUSIONS
  Siblings of maltreated, multiple-gestation children often, but not always, were abused. In sets with two maltreated children, children usually shared the same modes of maltreatment. Multiples are significantly more likely than singletons to be younger and experience fractures and abdominal trauma. The findings support the current standard practice of evaluating all children in a multiple set when one is found to be abused or neglected.
authors.affiliation: Division of General Pediatrics, Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9063, USA; Children's Medical Center Dallas, 1935 Medical District Dr., Dallas, TX 75235, USA.
authors.forename: Cathleen A
authors.initials: CA
authors.lastname: Lang
authors.affiliation: Division of General Pediatrics, Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9063, USA; Children's Medical Center Dallas, 1935 Medical District Dr., Dallas, TX 75235, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Cox
authors.affiliation: Division of General Pediatrics, Department of Pediatrics, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9063, USA; Children's Medical Center Dallas, 1935 Medical District Dr., Dallas, TX 75235, USA; Department of Clinical Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX 75390-9063, USA.
authors.forename: Glenn
authors.initials: G
authors.lastname: Flores
mesh_terms: D000007:Abdominal Injuries / Q000453:epidemiology*; D000367:Age Factors; D002648:Child; D002649:Child Abuse / Q000706:statistics & numerical data*; D002675:Child, Preschool; D005191:Family Characteristics; D005260:Female; D050723:Fractures, Bone / Q000453:epidemiology*; D006801:Humans; D007223:Infant; D008297:Male; D009099:Multiple Birth Offspring; D012189:Retrospective Studies; D012307:Risk Factors; D014427:Twins
keywords: CPS; Child Protective Services; Child abuse; Child maltreatment; Multiple births; Multiple gestation; Neglect; Twinning