Studies have tried to determine if shaken baby syndrome is distinct from serial abuse or a symptom of serial abuse. The absence of external signs of trauma after shaking allows people to think such behaviour is not child abuse and, in the past, has made accurate diagnosis difficult for medical professionals. Lumbar puncture was advocated by some physicians. Increasingly, studies were indicating that the examination of retinal hemorrhages by an ophthalmologist as the most reliable method of diagnosis. Virtually every study since the 1940's has recommended more information and education for parents, educators, health care workers, social workers and medical professionals.
Case studies indicate that often there has been no intention to harm on the part of the caregiver.
There are far too many individuals who are not aware of the danger of violently shaking a child. More shaking is done by males than by females. The repetitive nature of the act suggests a lack of self-control or rage indicating the real possibility of previous or future abuse. Often a caregiver doing the shaking is not the parent, but a baby-sitter, boyfriend or even the baby's sibling. Child-care professionals are in a unique situation to intervene with education.