The American Medical Association says cheerleading should be considered a sport because of its rigors and risks.

The nation's largest doctors' group adopted that as policy Monday at its annual meeting in Chicago. AMA members say cheerleading is as rigorous as many other activities that high schools and the NCAA consider sports. Adding it to the list would mean more safety measures for cheerleaders and proper training for their coaches.

Cheerleading is a leading cause of catastrophic injury in female athletes at the high school and college level, Dr. Samantha Rosman, a Boston-area pediatrician, told AMA delegates during floor debate before the vote.

"These girls are flipping 10, 20 feet in the air," Rosman said. "We need to stand up for what is right for our patients and demand they get the same protection as their football colleagues."

The new policy means the AMA supports having appropriate accrediting bodies declare cheerleading a sport, and supports better safety measures including avoiding inappropriate surfaces when performing flips and other stunts and following rules for properly performing stunts.

The policy echoes one adopted by the American Academy of Pediatrics two years ago.

In other action Monday, the AMA said transgender people should be able to switch the sex designation on their birth certificates without having sex-change surgery.

Most states make the operations a prerequisite. But the new AMA policy acknowledges that gender identity doesn't always match a person's birth anatomy.

An AMA report says identification documents that are consistent with gender identity rather than anatomy is essential to basic social and economic functioning.

The report also says patients deserve medical care that is appropriate to their birth anatomy even if they self-identify as the opposite sex.

The new policy won praise from the National Center for Transgender Equality.

"The AMA's support for eliminating surgery requirements to update their birth certificate will send a strong message to states that lag behind on these policies," Mara Keisling, the group's executive director, said in written statement. "Currently only five states and the District of Columbia have modernized their policies to make it clear that surgery is not required to update a birth certificate.

"Transgender people should not be required to have any specific, costly medical treatments in order to carry the accurate and consistent ID we all need to function every day in the United States."

The AMA's five-day meeting includes Tuesday's swearing-in of a new AMA president, Dr. Robert Wah. He is 56 and a reproductive specialist in McLean, Virginia.