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The Choking Game

The Choking Game has drawn more attention with the publication of ‘Unintentional Strangulation Deaths from the “Choking Game” Among Youths Aged 6-19 Years’ in the February 15, 2008 issue of the Morbidity and Mortality Weekly Report, published by the Center for Disease Control.   This latest national examination of the Choking Game reports 82 probable deaths among young people during 1995-2007.  Most of the victims were male, with a median age of 13 years old.   You may access the MMWR preview report and editorial note here.
For an in-depth examination of the Choking Game, including signs your child may be playing and some tips for dealing with the situation, please continue reading.

Beware the Choking Game

A 14-year-old Vermont boy died the last week of February 2006. He was a wrestler and the president of his eighth grade class.  He wasn’t in a car accident.  He wasn’t drunk.  He wasn’t on drugs. He suffocated to death while pursuing a ‘natural high’ as part of a game. 

The Choking Game claimed at least ten American youngsters’ lives in the first two months of the year, from California to Iowa; Oklahoma to Connecticut; Minnesota to New Hampshire.   The youngest victim was ten years old.  While there have not been any reported deaths tied directly to this game in South Dakota, middle school students have admitted to playing it.

What Happens When Someone Plays the Game
Who's Playing the Game
Warning Signs
Prevention and Intervention Tips

Kids are fascinated by the fact that they can get themselves high without using drugs.  Most kids who try it are high achievers who are not using drugs or alcohol, kids looking for a thrill or those who are seeking a “secret” activity.

Kids play it alone, with a friend or in a group.  The aim is to pass out from a lack of oxygen – creating a 'floating', 'tingling', 'high' sensation.  The ‘high’ comes from brain cells seizing and beginning the process of permanent cell death.  When the victim loses consciousness, the pressure is released and the secondary 'high' of the blood rushing to the brain is achieved.  These feelings alone can be addictive.  Kids know it's risky and dangerous - that's part of the allure of the game.  Some get involved when they are dared; some kids find it entertaining to see others lose consciousness.
What they (and few adults) know is that the Choking Game is deadly serious. 

From the online encyclopedia Wikipedia

“There are actually two distinct methods involved, which tend to get confused, strangulation and self-induced hypocapnia as follows:
Strangulation restricts the blood flow to the brain by compressing the carotid artery in the neck. This is achieved either by pressing the thumbs against the arteries on both sides of the neck simultaneously or the use of a ligature. The use of thumbs on the neck can be self-induced and usually stops automatically on blackout. Where an assistant applies hand pressure, and in all cases where a ligature is used, stopping at the right moment before permanent damage occurs becomes a judgment on the part of the operator or just good luck. Self-strangulation through the use of a ligature is the most common cause of death or brain damage although many schoolchildren have accidentally killed or caused permanent brain damage to their friends by all methods. It is believed that many deaths attributed to suicide by adolescents are actually solo self-asphyxiations and death was an unintended outcome. The method came to prominence in the news media and involved the use of a ligature. An accomplice would hold the belt or rope around the victim's neck. When they were seen to go limp the accomplice would then release the pressure. If the blood flow is restricted for too long or if the pressure is placed at the base of the brain stem, strokes, cardiac arrest, brain damage and death may occur. In both strangulation and self-induced hypocapnia blackouts the victim may experience dreaming or hallucinations, though fleetingly, and regains consciousness with involuntary movement of their hands or feet much to the amusement of the onlookers. Full recovery is usually made within seconds but these activities cause many deaths and invalidities every year, particularly when played alone or with a ligature. Permanent brain damage may not be immediately apparent.” 

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What happens:
When the brain is deprived of oxygen and/or blood, cells immediately start to die. Plus, any of the following could happen the first or any time:

Bruises/concussions (from falling after passing out)
Short term memory loss
Brain Damage
Retinal hemorrhaging
Cardiac arrest
Brain Death (permanent vegetative state)

Although there are not firm numbers, many researchers say a high percentage of suicides by suffocation (especially among kids/teens/young adults) are actually victims of the Choking Game.

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Who's Playing?
Parents and teachers may think the youngsters in their lives would never get involved in such a dangerous activity.  But, remember, a majority of kids see the Choking Game as risky – not deadly.  Who plays the game?
 Primarily kids in from 9-15 years old, in middle school, will be the players.  But that is by no means exclusionary.  Kids as young as 6 or 7 have been injured playing, and so have young adults up through their late 20s.

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Warning signs:
Bruising or red marks around the neck (
sometimes hidden by means of a turtleneck, a scarf or a permanently turned-up collar)
Ligatures (bed sheets, belts, tee-shirts, ties, ropes) tied in knots (
questions about such objects are often eluded)
Wear marks on furniture (bunk beds, closet rods) from previous incidences
Disorientation after being alone
Unusual need for privacy (locked bedroom doors)
Bloodshot eyes, pinpoint bruising around the eyes
Changes in attitude (aggressive behavior)
Headaches, sometimes excruciatingly bad ones
A thud in the bedroom or against a wall – meaning a fall in cases of kids playing the game alone.

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It is essential to talk to children about the dangers of choking themselves or others -
keep in mind they feel it's 'just passing out' because it's not doing drugs or illegal behavior.  Tell them that EVERY time they play this kind of game they are risking death -either brain cells or themselves. 

If you know your child is actively participating:
• Increase supervision- be aware of your child’s activities and whereabouts
• Remove any paraphernalia that could be used as a ligature.
• Alert school personnel (the Prairie View Prevention Services prevention counselor at your child’s school, the principal, nurse, school counselor, school police, teachers, etc.)  If one student is involved, there probably are others involved.
• Alert the parents of your children’s friends.
• Consult with a physician to explore and address any health needs that have
resulted due to participation in this activity.
•If an older teen is involved, younger children in the same family may be at risk
for participating in this activity.

The Choking Game is also known as Blackout, Fainting Game, Space Monkey, Dream Game, Suffocation Roulette, Pass-out Game, Flat Liner, California Choke, Space Cowboy, Airplaning, Purple Dragon and many more nicknames.

Sources and resources: Deadly Games Children Play; Stop the Choking Game; The Choking Game – The Dylan Blake Foundation for Adolescent Behavior; Wikipedia

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    2000 Prairie View Prevention Services, Inc.