Cheerleading is more athletic than ever before - and becoming more dangerous than ever before, warns the country's leading group of pediatricians.
Long gone are the days of just jumping and waving pompoms, says the American Academy of Pediatrics, which is calling for cheerleading to be designated as a sport to improve safety measures.
"Not everyone is fully aware of how cheerleading has evolved over the last couple of decades. It used to be just standing on the sidelines and doing cheers and maybe a few jumps," said Dr. Cynthia LaBella, a sports medicine specialist at Chicago's Lurie Children's Hospital and an author of the new policy.
Cheerleading has accounted for approximately 66 percent of all catastrophic injuries in high school girl athletes over the past 25 years, according to the academy. Girls make up 96 percent of U.S. cheerleaders over the age of six in the United States.
The number of cheerleaders injured each year has climbed dramatically in the last two decades. Common stunts that pose risks include tossing and flipping cheerleaders in the air and creating human pyramids that reach 15 feet high or more.
In a new policy statement released online Monday in the journal Pediatrics, the academy says school sports associations should designate cheerleading as a sport, and make it subject to safety rules and better supervision. That would include on-site athletic trainers, limits on practice time and better qualified coaches, the academy says.
Just like other athletes, cheerleaders should be required to do conditioning exercises and undergo physical exams before joining the squad, the new policy says.
LaBella said cheerleading often results in injuries that include severe sprains, broken arms and legs, neck injuries and concussions.
Last year, there were almost 37,000 emergency room visits for cheerleading injuries among girls aged 6 to 22, according to data from the Consumer Product Safety Commission -- more than four times higher than in 1980.
"This becomes an important message to parents as well as their coaches and trainers who are well aware of the potential for catastrophic injury, if safety is not made a key priority," Dr. Robert Glatter, an emergency medicine physician at Lenox Hill Hospital in New York City, told CBSNews.com in an email. "I have treated cheerleaders who have suffered concussions, cervical spine fractures, as well as wrist fractures and finger dislocations."
While there are still traditional cheerleading squads that support schools' athletic teams, some schools and private clubs have separate cheerleading teams that compete against other teams.
Kali Wald of Elburn, Ill., suffered a serious concussion last year during an acrobatic routine with her high school's competitive team; teammates tossed her in the air but she landed wrong twice, first on her upper back and neck, then on her head. She blacked out for several minutes.
Her father, Dave Wald, said her coaches didn't realize she was seriously injured and never called an ambulance. She still has short-term memory loss and can't attend school full-time because of dizziness, headaches and other concussion symptoms.
Kali, 18, said she believes that cheerleading should be considered a sport and made safer. Her father agreed and said there needs to be better awareness about the rigors of cheerleading and the potential risks.
Injuries have increased as cheerleading has become more popular. Data suggest there are more than 3 million cheerleaders nationwide aged 6 and older, mostly girls. That includes about 400,000 in high school, according to data cited in the new policy.
While the overall injury rate in high school cheerleading is lower than in other girls sports, including gymnastics, soccer and field hockey, the rate of catastrophic injuries like skull fractures and paralyzing spine injuries is higher, the academy noted.
Kasey Bronstein, 14, and her sister Kori, 17, of Mahwah, N.J., both tore a knee tendon while cheerleading for a private competitive team run by their parents. They twisted their knees doing acrobatic moves while standing on the raised-up hands of their teammates. They had knee surgery last November, followed by extensive physical therapy, and have returned to cheerleading.
Both said it should be considered a sport but they also think it's already pretty safe.
"They're kind of making it too safe, taking out skills that are very exciting to do," Kori said, such as double flip stunts her team has barred.
Some schools and state high school sports associations already consider cheerleading a sport and require the kind of safety oversight that the academy is recommending. But many do not, said Jim Lord, executive director of the American Association of Cheerleading Coaches & Administrators. Some don't consider it a sport because not all cheerleading squads are involved in their own competitions, he said.
Lord said the academy's policy mirrors many of his group's safety recommendations for high schools and colleges. That includes limiting the height of human pyramids in high school cheerleading to just two people. The academy also says routines that include pyramids, tumbling or tosses should not be performed on hard surfaces.
"Most of this is actually stuff we've recommended for quite a while," Lord told Reuters. He however criticized the recommendation for performing pyramids and stunts on foam or spring floors, saying it may disrupt balance.
"That would actually increase injuries dramatically," he said.
Lisa Kluchorosky, a sports medicine specialist who works with the academy and the National Athletic Trainers Association, said the new policy will help erase misconceptions that cheerleading is not very athletic.
"The statistics are compelling and you can't turn your head from that," she said.