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I think it should only be used as a nickname for Elizabeth and even then it's a bit precious. In the "Betsy" books by Maud Hart Lovelace, the ones when Betsy is a teenager, not a child, some character calls Betsy Bettina rather than Betsy, but I can't remember who it was. Her friend-later-husband-Joe? Or was it Tacy?

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ETA: Pretty sure I remember. It was her sister Julia.

This message was edited 8/26/2016, 8:25 AM