November 15, 2013

Helmet Claims Don’t Stand Up in Preventing Football Concussions

The topic of sports-related concussions, especially from football, remains front and center among health professionals and any player or parent who cares about his brain function. Equipment manufacturers have jumped aboard the protect-your-head bandwagon, but, as a recent story on makes clear, helmet product claims of reducing the risk of injury aren’t borne out by the facts.

We’ve reported on concussion-related brain injury and the ways in which product manufacturers have tried to address it.

Summarizing research presented at a meeting of the American Academy of Pediatrics last month, USNews reported that “… neither the brand nor the age of a helmet is associated with fewer concussions in young athletes, …”

During the 2012 football season, researchers tested a variety of mouth guards and football helmets worn by 1,332 high school football players from 36 different schools. The players had completed a pre-season questionnaire about previous injuries. The athletic trainers reported the number and severity of sports-related concussions throughout the season.

At season's end, no significant difference was found in the frequency of concussions among players, regardless of the brand or age of their helmets. And the severity of the concussions, as measured by the number of days players were absent from play, was no different among players wearing different brands. Among the brands tested were Riddell, Schutt and Xenith.

Many helmets promoted for reducing the risk of concussion are more expensive, so the researchers questioned the wisdom of investing in such equipment.

According to the Centers for Disease Control and Prevention (CDC), more than 173,000 recreation-related traumatic brain injuries to children and adolescents are treated in U.S. emergency departments in the United States every year. Boys between 10 and 19 who play football are far more likely to suffer such injuries. Nearly 3 in 4 ER visits for brain trauma are among males, and most often involve football or bicycling. The recent research showed that about 40,000 sports-related concussions occur in U.S. high schools every year.

Although helmets reduce the risk of skull fractures and scalp injuries, the researchers doubt that they’ll ever be able to protect athletes completely from concussions and brain injuries. That’s not likely, as the chief researcher told USNews, "because the brain is floating freely inside the skull, I think most experts doubt whether it is possible to ever develop a helmet design that can prevent concussion."

Gregory Myer, director of research for the Division of Sports Medicine at Cincinnati Children's Hospital Medical Center, said it's difficult to protect the brain from the outside, especially when you add mass to an athlete's head with a helmet.

"That's why we've seen no reduction in the number of concussions from the development of any helmet," he told USNews.

You can prevent the incidence and severity of concussions by increasing peripheral vision to enable a player to avoid or prepare for a collision, and by improving neck strength. But Myer said it's possible that helmets could increase the risk of concussions.

That comes from a sense of invincibility—some players might be less fearful if they’re wearing a helmet they believe has protective powers that it doesn’t.

"They're more likely to use their head as a weapon," Myers told USNews. "If you took that away, athletes would never lead with their head."

Learn more about concussions on, an informational website of the American Academy of Pediatrics.

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June 21, 2013

Bicycle Helmets Save Lives and Brains

Riding a bicycle without a proper helmet is a no brainer—that is, you risk losing your brain if you fall off a bike with an unprotected head.

Now, a new study published in the Journal of Pediatrics confirms the common sense of always wearing a helmet. It says that bike helmet laws seem to prevent more head injuries and deaths than formerly believed, a conclusion that contradicts another study questioning the safety value of bicycle helmet legislation.

As interpreted on, the Pediatrics research analyzed data from the Fatality Analysis Reporting System (FARS) of bicyclists younger than 16 who died between 1999 and 2010. FARS is a nationwide census providing the National Highway Traffic Safety Administration (NHTSA), Congress and the public with yearly data about fatal injuries suffered in motor vehicle traffic crashes.

Those data indicated that states with mandatory bike helmet laws had a 20% lower fatality rate than those that didn’t.

But a study published in the British Medical Journal (BMJ) that analyzed Canadian laws between 1994 and 2003 found no effect of bike helmet laws on child fatalities. (It defined young people as those younger than 18.)

Although that study concluded that injury rates declined in provinces that had bike helmet requirements, researchers said the decrease wasn’t the result of helmet laws because injury rates had begun to decline when the legislation was enacted, and they didn’t continue to decline after the laws were in place.

The BMJ researchers attributed the lower injury numbers to improved public education about bike safety, safe-riding media campaigns and wider availability of subsidized helmets.

But let’s look at that conclusion with a critical eye: Doesn’t it logically follow that if you are a better informed cyclist you understand the necessity of wearing a helmet? Why would authorities subsidize helmets if they weren’t clearly protective, if there wasn’t a clear benefit?

More than 900 people die each year from bicycle collisions, according to AboutLawsuits, and about 3 in 4 of those fatalities were caused by a head injury.

Every bicyclist, young or old, should wear a helmet. Parents should set the right example by wearing a helmet when they ride, and they should require their kids to wear one from the first time they get on a trike.

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March 29, 2013

Getting Back Into the Game After Suffering a Concussion

When we wrote about kids and concussions a while ago, the discussion concerned the rising awareness of how getting your head banged during an athletic competition can lead to traumatic brain injury, and that sports equipment manufacturers were responding by designing more protective gear.

How quaint. As of last week, the guidelines for treating kids who suffer a head injury on the field of play have become more stringent. At least that’s what the American Academy of Neurology advises.

As reported by the Associated Press, when athletes are suspected of having a concussion, they should be taken out of action immediately and shouldn't resume playing until they've been fully evaluated and cleared by a doctor or other professional with concussion expertise.

The academy’s recommendations support a position paper it issued in 2010, but the new guidelines are a more complete document for evaluating and managing a head injury based on a comprehensive review of scientific research.

The guidelines replace those published 15 years ago that advised grading the severity of a concussion at the time of injury as a way to measure when the player could return to the game. The new recommendations emphasize individual player assessment and management of the injury when it occurs, and are not flexible about returning to play: Don’t do it.

Athletes should not be allowed back into the game if they show any symptoms, such as dizziness, muddled thinking, blurry vision, headaches or nausea. The guidelines also say players of high school age or younger with a diagnosed concussion should wait much longer to return to action than older athletes.

AP pointed out that the research showed that the grading system didn't provide useful information about outcomes, and that recovery from concussion is not predictable—some people recover faster than others. But the first 10 days after a concussion, according to the guidelines, are when a player is at the highest risk of getting a second concussion

And getting that concussion before the first one is healed can lead to longer periods of disabling symptoms. Sometimes the damage, including mental impairment, memory loss, headaches and mood disorders, can be permanent.

So, parents, coaches and trainers, if a child of yours bangs his or her head in the course of the game and is seeing stars, having trouble with balance, unable to focus or complaining of headache, that child does not belong in the contest that day and for days to come. At least.

If your child’s coach (or any other authority) encourages him or her to just shake it off and get back into the game, it’s time to find another place to play.

To learn more about concussions, link here on website of the American Academy of Neurology.

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November 16, 2012

Sleep-Deprived Teen Athletes Suffer More Injuries

When you’re sleepy you’re more likely to make mistakes. And, it appears from research presented last month at a conference of the American Academy of Pediatrics, lack of sleep puts adolescent athletes at greater risk of injury.

Researchers studied middle- and high-school athletes in grades 7 to 12 for nearly two years. They found that those who slept eight or more hours every night were significantly less likely—68 percent—to be injured playing their sports than those who regularly slept less.

The study admittedly was small—it surveyed kids at only one California school. And it relied on students remembering and communicating accurately. But the premise, really, is a no-brainer: Insufficient sleep is not good for you, in many ways.

In addition to their sleep habits, students were asked about what sports they played, the time they spent playing sports either at school or in other programs, if they used a private coach, if they participated in strength training and how much they enjoyed their athletic endeavors. Split nearly evenly between boys and girls, 112 of the 160 students completed the survey, which was done in conjunction with Children’s Hospital Los Angeles.

The study’s author, Dr. Matthew Milewski, said, “While other studies have shown that lack of sleep can affect cognitive skills and fine motor skills, nobody has really looked at this subject in terms of the adolescent athletic population.”

In addition to hours of sleep per night being clearly associated with the incidence of injury, results showed that the higher the grade level of the athlete, the higher the likelihood of injury. Each additional grade level was associated with a 2.3 higher chance of getting hurt playing sports. No other element—gender, duration/hours of participation, number of sports played, strength training, private coaching or “fun” factor—showed a significant association with injury.
Milewski said that the association between higher grades/ages and increased chance of injury might reflect the cumulative effect of playing sports for several years as well as the fact that older kids are bigger, faster and stronger.

As reported on MedPage Today, the injuries involved multiple body parts. Most common, however, were injuries to the hand or wrist, knee, shoulder, ankle, back and head.

More than 38 million children participate in organized sports each year, according to MedPage Today. Approximately 1 in 10 is treated for a sports injury. Milewski said about half of all injuries probably are related to overuse, and half of those are probably preventable.

During the school study, nearly 6 in 10 athletes were injured; nearly 4 in 10 were hurt multiple times.

As MedPage reports, the Centers for Disease Control and Prevention and the National Sleep Foundation define insufficient sleep for high schoolers as fewer than eight hours per night. And the eight-hours threshold in this age group, Milewski said, is regularly missed—approximately 7 in 10 high schoolers don’t sleep that much. More than 3 in 4 four students involved in the survey said they slept fewer than eight hours. (See our post about how teenagers’ love of texting contributes to sleep deprivation.)

If parents needed another reason to nag their kids, the greater risk of getting hurt at play is a pretty good one: Tell your kid to log off of Facebook, turn off the smartphone and go to bed.

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February 28, 2012

CT Scans for All Kids with Head Injuries?

From high-profile former NFL players to soldiers returning from Afghanistan, the emerging picture of head trauma is not pretty. And of course the lingering, often-delayed effects of traumatic brain injury (TBI) aren’t limited to adults.

We’ve talked about children at risk of concussion when they play sports, and how manufacturers are developing “anti-concussion” athletic equipment.

Writing on, malpractice attorney Maxwell S. Kennerly suggested that some practitioners still aren’t taking head injuries to children seriously enough.

Last year, he noted, the Centers for Disease Control and Prevention (CDC) reported “a growing awareness among parents and coaches, and the public as a whole, about the need for individuals with a suspected TBI to be seen by a health-care professional.” He pointed to the CDC’s Heads Up initiative as exemplary of efforts to raise consciousness that seeing stars isn’t a badge of athletic honor, it’s a reason to seek medical care.

What remains questionable, Kennerly wrote, is how prepared emergency and primary care physicians are to handle the increased number of head trauma cases they’ll see as a result of greater awareness of the problem.

“Viewed through a narrow lens, the solution to a suspected brain injury is obvious,” he wrote. “[I] f a kid complains about anything relating to their head, give them a CT scan. But CT scans come with their own costs and risks, not least exposing a developing brain to a year’s worth of background radiation.”

Too often medicine overtreats patients because technology enables it, insurance pays for it and/or doctors are worried about being challenged if they fail to perform every test within reach. Often a more conservative approach is better for the patient.

But when it comes to kids and head injuries, in deciding whether to order a CT scan for a kid with new head trauma, Kennerly says the conservative treatment approach is wrong.

“I’m not here to tell you where the CT / no-CT line should be drawn,” Kennerly claimed. “I can tell you, however, how I would draw that line as a medical malpractice lawyer when a parent comes in and tells me their doctor didn’t order a CT scan after a minor head trauma and their child later developed serious sequelae [i.e., a brain injury]."

In the world of medical malpractice, such a circumstance is known as “failure to diagnose.” As Kennerly explained, laypeople—like jurors—might well respond to the concept of incremental risk a witness might offer to defend against the charge of failure to diagnose. “One head CT scan,” the witness might say, “has more radiation than 20,000 trips through the TSA scanner at the airport.”

That sounds scary. But is it scarier than risking chronic, lifelong problems with the ability to think, loss of memory, headaches, attention deficit, mood swings and the other markers of brain injury?

Kennerly cited an article published in the January issue of Critical Decisions in Emergency Medicine, “Evaluation of Minor Head Trauma in Pediatric Patients," that argues for CT scans for children who present with any evidence of brain trauma.

If you’re the parent of a child who has fallen from a great height, who has emerged woozy from a collision in soccer, who claims his or her vision is blurred from a bang on the noggin, take him or her to your physician or emergency room immediately. And if the child doesn't show full recovery of normal consciousness very quickly, without any symptoms of brain trouble, a CT scan could be in order.

A British website offers guidelines for CT scans for anyone younger than 16 with a head injury, and the CDC's Heads-Up site helps observers spot the signs of concussion. They are:

  • loss of consciousness;

  • loss of memory;

  • abnormal drowsiness or sluggishness;

  • nausea or vomiting;

  • bruise, swelling or laceration on the head, behind the ears;

  • bruising around the eyes ("panda" eyes);

  • fluid leakage from ears or nose;

  • confused, dazed or stunned appearance;

  • personality changes;

  • headache;

  • problems balancing or abnormal clumsiness;

  • double or blurry vision; or

  • abnormal sensitivity to light or noise.
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November 2, 2011

Concussions and Kids and Consumers' Pocket Books

A hot topic in the world of sport safety these days is concussion. It’s not the first time we’ve covered the topic. Thanks to an increasing awareness that concussions can lead to traumatic brain injury (TBI), cognitive decline and other problems, athletes are monitored more closely for signs of head injury.

But greater awareness and better medicine have a concussion traveling companion of a decidedly consumer orientation. So-called “anti-concussion” sports equipment is making its market move. As always, it’s buyer beware.

As reported in the Los Angeles Times, no piece of equipment, no matter how technologically advanced, can indicate the presence of brain damage, or guarantee protection from it.

Testifying a couple of weeks ago at a U.S. Senate hearing, Jeffrey Kutcher, chairman of the American Academy of Neurology's sports section, said, "I wish there was such a product on the market. The simple truth is that no current helmet, mouth guard, headband or other piece of equipment can significantly prevent concussions from occurring."

Parents are a target market for these products, and football is a prime activity.

  • Item: a $149 chin strap made by Battle Sports Science called the Impact Indicator that features colored lights to "help" indicate whether a player has a concussion.

  • Item: the Brain-Pad LoPro mouth guard, which promises "brain safety space.

  • Item: Riddell's Revolution helmet, whose pitch is to reduce the number of concussions by 31%. Kutcher said research showed that the helmet decreased concussions by only 2.6%.

Good equipment is key, whether you’re a 12-year-old middle linebacker or a 47-year-old softball catcher. But the best way to prevent brain damage (or worse) after a head injury is to take the time necessary to recover. Children have relatively heavier heads than adults, and because their brains are still developing, the incidence and severity of their head injuries is higher.

According to the Centers for Disease Control and Prevention (CDC), the number of traumatic brain injuries among young athletes has increased 60% over the last 10 years. In 2001, 153,375 young athletes were admitted to emergency rooms for concussions and other sports-related head injuries. In 2009, that number had climbed to 248,418. Approximately 298 youths per 100,000 suffered a head injury in 2009. Males 10 to 19 had the highest rate of injuries.

Motorcycle and auto accidents account for about 20% of traumatic brain injuries. According to the CDC, the most common sports and games leading to TBI are:

  • bicycling

  • playground activities

  • football

  • basketball

  • soccer.

It’s difficult to resist the appeals of a kid who can’t wait to get back into the soccer game. But if she was dizzy, nauseous, had vision problems or a headache, even momentarily, she’s done until a doctor examines her. And certainly anyone who has gotten knocked out should be seen by a doctor immediately.

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August 23, 2011

Join the Movement to Prevent Concussions and Their Aftermath

Time was, if you “got your bell rung” on the field of athletic play, it was a badge of honor. And if you could “shake it off” and get back into the game, you were a stud, and a role model for the rest of your teammates and spectators.

How quaint. In recent years, studies have proved that a concussion — having your “bell rung” — is not something to banner on your jock resume, but a signal to slow down, recuperate and accept that concussions can be precursors to brain damage.

It is critical, especially, that parents receive and understand this message. Although equipment manufacturers, trainers, doctors and coaches are beginning to embrace the need to protect against concussion, there’s still a macho element of sports competition that believes you’re supposed to play through pain.

A story about wiser heads prevailing appeared recently in the New York Times, which profiled a new initiative by a sporting goods chain to prevent and treat concussions in student athletes. Dick’s Sporting Goods is sponsoring neurocognitive testing of more than 1 million athletes to establish a baseline of healthy brain activity.

Referred to as ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing), the tests profile each student’s baseline of brains functions such as verbal and visual memory and reaction time. The results are compared with the results of the same tests given in the event of a suspected concussion. If the comparison signifies deterioration, the player is benched until deemed healthy enough to resume play.

Called Protecting Athletes through Concussion Education (PACE), the program employs a diagnostic procedure also used by professional sports associations including the National Football League, Major League Baseball and the National Hockey League.

As The Times’ story notes, approximately 300,000 sports- or recreation-related concussions are diagnosed nationwide yearly, but, according to the American College of Sports Medicine, approximately 8 in 10 concussions go undiagnosed.

There’s information, and there’s the useful application of information. To boost the chances of concussion-awareness getting through to student jocks and their parents, Dick’s has employed the services of former Pittsburgh Steelers’ running back Jerome Bettis in a commercial to convey the importance of baseline testing.

Known during his career as “The Bus” for dragging defenders down the field, he’s featured with a football helmet and saying, “You wouldn’t get on the field without this — and you shouldn’t get on the field without a baseline concussion test either.”

As reported by The Times, Bettis had several concussions, and said that he wished he had known more about the symptoms and the potential long-term impairment. “[H]ad I known then what I know now,” Bettis said, “I would have handled it differently and I would have told the trainers, because the last thing I want is 20 years down the road to not have my brain function correctly.”

If your children participate in sports or a recreational activity with even the slightest potential for head injury, ask the school, athletic association or your physician how to get a baseline concussion test. And stay involved during the season — ensure that equipment is adequate, and that the coaches, trainers and other adult supervisors are as concerned about head injury as you are.

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January 6, 2011

Senator seeks FTC probe of football helmet makers

A U.S. senator is leading the charge to have the Federal Trade Commission investigate "misleading safety claims and deceptive practices" in the selling of new and used reconditioned football helmets.

In a letter to the FTC, Tom Udall, the Democratic senator from New Mexico, charges that helmet companies "appear to be using misleading advertising claims" and that "some helmet reconditioning companies may be falsely selling used helmets as meeting an industry safety standard."

In the letter, Udall singles out “misleading" marketing claims by Riddell, the helmet maker that supplies the official helmet to the National Football League, as saying on its web site that research shows "a 31 percent reduction in the risk of concussion in players wearing a Riddell Revolution football helmet when compared to traditional helmets, yet there is actually very little scientific evidence to support the claim."

Riddell’s CEO called Udall’s allegations “unfounded and unfair” and said the company welcomes “any scrutiny and review.”

In November, Udall asked the Consumer Product Safety Commission to investigate whether safety standards for football helmets are adequate to protect players from concussions. Udall serves on the Senate Commerce Committee, which oversees the Consumer Protection Safety Commission.

Source: Kentucky Post

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November 10, 2010

Tracking sports injuries to make athletics safer

Fred Mueller is not your casual weekend sports fan. The retired 74-year-old former professor from the University of North Carolina continues to run – almost single-handedly – the National Center for Catastrophic Injury Research (NCCIR) at UNC, tracking, logging and analyzing catastrophic injuries in football and other sports.

Over a 30-year span, Mueller has analyzed more than 1,000 fatal, paralytic or otherwise severe injuries to young athletes, looking for and identifying patterns that result in rule or other changes that increase athlete safety.

The data compiled by the NCCIR has its genesis in the “football death log” begun in 1931 by the American Football Coaches Association. In the 1960s, UNC began to oversee the log. After Mueller became director of the NCCIR in 1980, he expanded it to include catastrophic injuries in all sports, among boys and girls.

Almost immediately, Mueller noted a previously hidden cluster of injuries among polevaulters and swimmers. As a result, polevaulting pits were expanded and surrounded with softer padding, while minimum depths were established for diving into swimming pools.

And after he noted the high number of injuries among cheerleaders, specifically those who are thrown up to 25 feet high and not caught, cheerleading safety guidelines and universal standards were established.

So far this year, Mueller has logged 24 catastrophic football injuries; typically, there are 36 such injuries every year. He’s also just finished a book on football injuries co-written with Robert Cantu, MD, the NCCIR's medical director. Football Fatalities and Catastrophic Injuries, 1931-2008 details football’s decade-by-decade tragedies and rule changes — like the 1976 outlawing of spearing and more recent adjustments to kickoff wedges. A final chapter discusses injury prevention strategies and other ways to make football safer.

Source: The New York Times

To visit the National Center for Catastrophic Injury Research home page, click here.

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October 22, 2010

Portable soccer goals pose serious child safety hazard

Soccer moms and dads need to know that the portable goals used on many of their kids' soccer fields pose a serious safety hazard when they're not secured to the ground.

As many as half a million portable goals weighing up to 400 pounds are on American soccer fields, and if they aren’t secured properly, they can tip over and cause severe injury or even death.

According to statistics from the Consumer Product Safety Commission, at least 34 children have died since 1979 from injuries caused by soccer goals that tipped over. And each year, more than 200 players are injured.

Soccer goals are heaviest in the front and therefore can tip forward without warning when children climb or hang from the front bar (doing pull-ups or chin-ups, for example). Even a gust of wind can cause an unsecured goal to tip over.

If the goals are weighted down with stand bags or stakes, they won’t tip. Although referees are supposed to check each goal before every game to ensure they are being held down, parents should double check to ensure the goals are firmly in place.

Child safety experts also advise parents to talk with their soccer-playing children about the dangers of portable soccer goals. And, they say, the goals should be taken down when they aren’t in use to avoid accidents after the game is over.

Source: WRAL-TV Raleigh

Soccer parents can find a complete list of safety recommendations here.

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October 21, 2010

Kids' Football Helmets: Unsafe, Untested

Hundreds of thousands of youngsters who participate in tackle football are wearing helmets that are too old to protect them from dangerous brain concussions. And even new helmets provide little protection from concussion.

These are just two of several eyebrow-raising findings in a report from the New York Times. Writer Alan Schwarz says:

Helmets both new and used are not — and have never been — formally tested against the forces believed to cause concussions. The industry, which receives no governmental or other independent oversight, requires helmets for players of all ages to withstand only the extremely high-level force that would otherwise fracture skulls.

The standard has not changed meaningfully since it was written in 1973, despite rising concussion rates in youth football and the growing awareness of how the injury can cause significant short- and long-term problems with memory, depression and other cognitive functions, especially in children.

Even worse, the industry's few safety standards are flouted by companies that recycle old helmets, returning them in dangerous condition, according to the Times:

Some of the businesses that recondition helmets ignored testing rules, performed the tests incorrectly or returned helmets that were still in poor condition. More than 100,000 children are wearing helmets too old to provide adequate protection — and perhaps half a million more are wearing potentially unsafe helmets that require critical examination, according to interviews with experts and industry data.

Read more here.

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September 24, 2008

Cheerleader Injuries: The Darker Side of an All-American Sport

A leading sports injury expert says that cheerleading has become one of the riskiest sports for women. Lifelong pain and disability, paralysis and even death are becoming more common consequences of participation in cheerleading.

The expert, Frederick Mueller, points out that most people still think of cheerleaders as mere pompom-waving eye candy and do not realize that cheerleading can involve dangerous gymnastic exercises. Because of this, schools often will not label cheerleading as a sport and choose to class it with non-athletic activities like working on the newspaper or acting in a play. This labeling contributes to the dangers of cheerleading:

The main problem, critics say, is that cheerleading in most states is not considered a sport; it's an "activity" such as chess club and debating. As a result, it is not required to follow uniform safety regulations, such as mandating off-seasons, routine physicals and soft surfaces that would minimize injuries. Coaches are not required to undergo standardized training.

There are obvious ways to minimize this risk. The coaches and administrators of cheerleading organizations quoted in the article point out that approaching cheerleading with the same care schools use in recruiting and training coaches for sports like basketball and football would make the sport much safe. For instance:

Several organizations also offer training programs for coaches, including how to minimize risks, teach stunts properly and respond to medical emergencies.

Among those organizations are the American Association of Cheerleading Coaches and Administrators and the National Federation of State High School Associations.

If your child is or wants to get involved in cheerleading, it is a good idea to talk to the coach first and see what kind of training he or she has had. It would also be wise to ask about safety measures the coach plans to implement to protect the cheerleaders.

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May 2, 2008

Girl With Heart Disease Dies in Gym Class

Candi Martinez is filing a wrongful death suit against Las Cruces Public Schools because her daughter Destinie, who had heart disease, died after she was sent to gym class despite a note excusing her for medical reasons and then was kept from the hospital because the school called the wrong parents to obtain consent.

Destinie was kept in class even after she began vomiting.

This case (whatever its merits) reminds us of how the institutional nature of schools can lead to a child's individual medical problems going ignored by teachers and administrators, who may be too busy keeping general order to pay attention to an individual child.

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