A pediatrician is asked to judge a local cheerleading competition. During the event, an athlete is dropped during a stunt and loses consciousness briefly. “This is probably her third concussion that we know of,” the girl’s mom tells the pediatrician. “It just comes with the territory of being a cheerleader. I’m sure she’ll be fine.”
Cheerleading continues to grow in popularity. An estimated 3.5 million U.S. youths participated in 2022, most of whom were females 6-17 years old.
The demands for increased skill level and multiple opportunities for national competitions also have increased dramatically over the past 10 years. As a result, the number of injuries, including concussions, has risen.
An updated AAP policy statement from the Council on Sports Medicine and Fitness summarizes the latest evidence on the epidemiology of injuries and offers suggestions to improve the safety of cheerleading in the youth population. It also provides recommendations for pediatricians on anticipatory guidance and use of the preparticipation physical evaluation.
The policy Safety in Cheerleading: Epidemiology and Recommendations is available at https://doi.org/10.1542/peds.2024-068956 and will be published in the November issue of Pediatrics.
Injury risk
As with all sports, cheerleading comes with risk of injury. It is difficult to track injury rates, however, because not all states recognize cheerleading as a sport and no centralized surveillance system exists.
Studies using data from the National Electronic Injury Surveillance System, the High School Reporting Information Online database and other sources have reported on the most common injuries and catastrophic injuries.
The catastrophic injury rate has decreased with implementation of rule changes for stunting in 2006-’07. Meanwhile, concussions represent 31% of all cheerleading injuries, highlighting the importance of increased knowledge and awareness.
Data also highlight an increased injury risk in patients younger than 12 years. This population generally has no access to athletic trainers and lacks guidance on injury recovery and when to return to sport.
Injury rates are higher during practices and competitions compared to performances, making anticipatory guidance on sleep, nutrition and hydration, especially during competitions, paramount.
Overall health and well-being
Cheerleading is an aesthetic sport, and there is pressure for athletes to maintain a certain physique. Screening for risk factors for relative energy deficiency syndrome gives pediatricians an opportunity to have conversations regarding body image, low energy availability and bone health. It also provides an opportune moment to discuss how the menstrual cycle is a vital sign of health in females.
Now that the International Olympic Committee has given full recognition status to cheerleading and the ability to petition cheerleading to be included in the Olympic games, support and funding for cheer development may increase. In the meantime, pediatricians can support these athletes through anticipatory guidance at well visits and advocacy in the community.
Key actions and recommendations
- Advocate for school-based cheer to be overseen by associations in all 50 states to ensure access to qualified coaches, conditioning programs and injury tracking.
- Reinforce the need for coach certification through the USA Cheer Safety and Risk Management Course as well as for policies to prevent physical, sexual and emotional abuse, bullying and hazing.
- Encourage safe and developmentally appropriate skills training and a safe environment/venue to learn and practice skills.
- Ensure schools, coaches and athletes have access to emergency action plans and that plans are practiced regularly.
- Educate cheerleaders, coaches and parents on concussion recognition. Any athlete suspected of having a concussion should be removed immediately from activity.
Dr. King is a lead author of the policy statement.
