By Drs. Sally Robinson and Keith Bly

According to the American Academy of Pediatrics Section on Sports Medicine and Fitness, between 1982 and 2001, 50 percent of the catastrophic injuries to female athletes were in cheerleading. The increasingly competitive nature of the sport has lead to ever more dangerous stunts like tosses and pyramids.

If your daughter participates in cheerleading, athletic dance or ballet, she may be more exposed to a group of conditions caused by intense competition - eating disorders, amenorrhea (the absence of menstruation), and resulting decreased bone mineral density.

Delayed menstruation in teenage girls is most common in very thin or very athletic girls who are underweight, and whose bodies have not experienced the normal puberty-related increase in body fat that is required to trigger the beginning of menstrual cycling. Left untreated, the eating disorder and consequent absence of menstruation can lead to decreased bone density, putting girls at increased risk for osteoporosis and stress fractures.

Of the three sports - athletic dance, cheerleading and ballet - the latter is the most appearance oriented. Ballet lessons often occur in a group before a mirror. Girls cannot help but see competing girls and know that other girls can see them as well.

It is not uncommon for girls to come to the conclusion - whether on their own or from the suggestions of teachers, coaches or peers - that they need to lose weight. If they make the decision without adequate professional consultation, they may take the first step toward weakened bones and joints. Parents who suspect either disrupted nutrition or absent menstruation should consult with their daughter's pediatrician.

All three of the above sports should be considered high impact sports that may generate serious injuries. Twenty-two percent of all injuries in this category occur in ankles and are fractures, dislocations, bruises, sprains and strains. Gymnasts with weak arches who perform barefoot will suffer from shin splints and stress fractures in the bones of the foot. Because form dictates a landing with hands up and back hyperextended, performers are subject to spondylolysis - a stress fracture of the vertebra, in this case usually the fourth or fifth lumbar (the lowest) vertebra in the back.

Furthermore, growing bodies are in danger of skeletal growth plate injuries. In the long bones, such as bones in the arms and legs, there are growth areas at each end where lengthening occurs as a child grows. Sometime during the teen years, these areas close and are replaced with solid bone. An injured growth plate or growth area of these arm and leg bones that doesn't heal can result in stunted growth and other skeletal problems.

Parents need to remember that while their daughters may wear short skirts and wave pompoms, they are involved in highly competitive and intense sports with little or no protective gear.

Do not encourage your child to "play through the pain" of sudden injury. If pain persists and makes a sport intolerable, or if you see a visible distortion of arms or legs, or if a child favors an injured limb, take her to the doctor.

Dr. Sally Robinson is a pediatrician in the division of children's special services at the University of Texas Medical Branch at Galveston. She teaches medical students about caring for children with chronic medical conditions. Dr. Keith Bly is a hospitalist and assistant professor of pediatrics at UTMB.

The Your Health column is written by health and medical experts at the University of Texas Medical Branch at Galveston. The column focuses on topical health issues that we believe are of interest to your readers. It is e-mailed every Tuesday. If you have any questions about the column, or would like to suggest topics, please contact John Koloen, media relations specialist, at (409) 772-8790 or email