Gone are the days when cheerleading meant enthusiastic chanting and the waving of pompoms. Modern cheerleading is a competitive sport that incorporates gymnastic stunts, flips, tosses and human pyramids. It's no surprise, then, that cheerleading injuries, like the cheerleaders themselves, have soared. 

A University of North Carolina survey of catastrophic sports injuries among high school students from 1982-83 to 2010-11 reported 83 catastrophic injuries among cheerleaders, the highest number in any sport, exceeding even varsity football. The American Academy of Pediatrics (AAP) defines a catastrophic sports injury as a closed head injury (such as concussion), skull fractures and cervical spine injuries that cause permanent brain injury, paralysis or death. 

"Most serious injuries, including catastrophic ones, occur while performing complex stunts such as pyramids,” according to pediatric sports medicine specialist Jeffrey Mjaanes, MD. “Taking simple steps to improve safety during complex stunts could significantly decrease the injury rate and protect young cheerleaders.” 

The worst cheerleading injuries occur when the riskiest tricks misfire onto hard surfaces, reports a Colorado School of Public Health study, which found the most common cheerleading injuries are concussions, followed by ankle and wrist injuries. 

In 2012, Mjaanes co-authored a set of guidelines published by the AAP to help prevent injuries. The AAPs suggestions are as political as they are practical. The academy wants state educational boards to officially recognize cheerleading as a sport. “Designating cheerleading as a sport would require schools to provide “qualified coaches, better access to medical care and injury surveillance,” said pediatric sports medicine specialist and guidelines co-author Cynthia LaBella, MD, in a press release. 

More than half of U.S. states now classify cheerleading as a sport. (There is currently no central database or website that tracks these classifications.) Whether or not your state is one of them, parents can use these questions from the AAP’s guidelines to help evaluate their child’s cheerleading program.

  • Do cheer team members at your child’s school have access to qualified strength and conditioning coaches, and are they required to have a pre-season physical?
  • Does the cheerleading team practice in a safe and appropriate space, such as the school gymnasium, with mats and other safety equipment? Stunts should never be performed on hard, rough or slippery surfaces.
  • Are cheerleaders and coaches trained in proper spotting techniques? Are they required to master basic maneuvers before progressing to riskier stunts?
  • Does the team have a written emergency plan in place, and do all cheerleaders, coaches and parents have access to the plan?
  • Does the school athletic department have a concussion policy? And does the cheerleading coach follow it? Anyone suspected of having a head injury should immediately cease practice or competition, and should be evaluated by a doctor.
  • Injured cheerleaders should not return to practice or competition without the approval of a health professional.

For help asking all the right questions, parents can visit CheerSafe.org for research and advice.

Sarah Pinneo is the author of "Julia's Child" and "The Ski House Cookbook." She lives and works in Hanover, NH.