Objective: To identify factors predicting the medical examination of children living in a home with a child referred to child protection services (CPS) for suspected physical abuse. Methods: Medical providers at Children's Hospital of Pittsburgh referred 189 children for suspected physical abuse to CPS between November 1, 2004 and May 1, 2006 (index children). In these referrals, providers named 249 children sharing a home with these index children (contact children). We identified household, child and abuse characteristics that predicted medical examination of a contact child after CPS referral of an index child. Results: Sixty contact children (24%) underwent medical examination; 12 (5%) were reported for suspected abuse by the medical provider. Seventeen contacts had examinations at the same time as the index child. Among 43 contacts examined after the index child, children under 2 years of age had higher odds of examination (AOR 4.7, 95% CI 2.2-10.1). Contacts of Black index children with at least one household risk identified (intimate partner violence, mental health concerns, substance abuse or prior CPS involvement) had lower odds of examination (AOR 0.1, 95% CI less than 0.1-0.4). Conclusions: In our study, at least 5% of children living with a child with suspected physical abuse had findings concerning for abuse. We observed concerning disparities on the basis of race and identified household risk factors in the rate of medical examination of these contact children. Our results add to prior work suggesting social and racial disparities in medical and social assessment of child abuse. Practice implications: To our knowledge, this study is the first description of the medical and social response to children identified in a home with a child reported for suspected physical abuse. We believe that our results reflect a need for evidence-based protocols to reduce disparities in reporting and investigation of children with household exposure to abuse. (Contains 3 tables.