My 16-year old daughter has had two concussions — one while skiing, the other while biking. Now she wants to get into competitive cheerleading. Should I let her?
That depends on several factors. When were the concussions and how close together were they time-wise? If one of her concussions is recent — and especially if she is still experiencing post-concussive symptoms such as headache, fatigue, irritability, and sleep problems — taking on cheerleading or any other sport right now would be inadvisable. Balance can be affected and vertigo or dizziness can also be an issue following a concussion; these symptoms increase the risk of re-injury.
Two concussions within a few months would be a concern, especially if your daughter had not fully recovered from the first concussion before she sustained the second. The first concussion puts her at risk for what is called "second impact syndrome," in which the effects of the second brain injury are more magnified than they would have been had there been no first concussion. And a third concussion, should one occur with the cheerleading, would also have a great effect on the brain and increase her likelihood of having permanent problems.
As for cheerleading specifically, if your daughter is a "tossee" — the one who is tossed into the air and caught or who balances precariously on top of others — then this is particularly a concern. The "tossee" in a cheerleading squad is most at risk for falling. A "tosser" — the one who throws another person and catches her — is at lower risk of injury, but every person in the squad plays an integral role in their own and their teammates' safety.
I would recommend against participating in cheerleading until at least a year has passed since the second concussion. This is a conservative recommendation. There are no standard guidelines as to when a child or adolescent should return to sports after a concussion, though some are being developed in certain states. The guidelines that exist are developed for elite athletes who are now recognized to recover more quickly than younger athletes and are monitored more closely for the effects of a concussion.
Since the brains in children and adolescents are still growing, most experts agree that this makes the young brain more susceptible to the effects of the concussion and that it takes longer to recover.
So … "when in doubt, sit it out."
Dr. Jane Gillett was a neurologist certified by the Royal College of Physicians and Surgeons of Canada in both pediatric and adult neurology. She created and developed the Pediatric Acquired Brain Injury Community Outreach Program, Children’s Hospital of Western Ontario. She died in 2011.