Serious injury can occur to children who are shaken, especially if the shaking is repeated or part of a pattern of abuse. Serial abuse in connection with children who are shaken and their siblings has important therapeutic and legal ramifications. From an ongoing study of child abuse and head trauma, 12 of 24 victims of shaking that resulted in intracranial injury were identified who had coexisting evidence of direct external trauma. Seventeen children (71%) had evidence of prior abuse, neglect, or both, including 8 who had multiple intracranial hemorrhages. Of the 21 families represented, 9 had more than one child, 3 (3%) of which had several siblings who had been victims of child abuse. Shaking of children usually is not an isolated event, as it frequently has been preceded by other types of abuse.