Spring 2012
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Beware of the Choking Game


A chilling activity called "the choking game" is being played out by children across the country, including in the Austin area. However, this is no child's play; it is a game with potentially deadly consequences.

The choking game has led to the deaths of at least 82 children and adolescents since 1995, according to information on the Centers for Disease Control and Prevention website. Children may not think "fainting" is a big deal, but the activity can lead to devastating disability if death does not occur.

What Is the Choking Game?

"The choking game is a dangerous activity that older children and early adolescents sometimes play to get a brief high," said Caron Farrell, MD, PhD, a child and adolescent psychiatrist at Seton Mind Institute. "What it is really is self-asphyxiation. They cut off blood flow to the brain to get the sort of high feeling associated with it. Initially, when blood flow is cut off, there's a little bit of a dizzy feeling when the brain begins to become starved for oxygen. Some people report that is their goal; they like that feeling," she explained.

"There is also an effect of when pressure is released and the blood is allowed to flow back into the brain – there's another 'rush' kind of feeling," Dr. Farrell added. "The blood starts flowing into the brain again and they get this euphoria, an overall warm, tingly feeling."

What kids don't realize is that after just a short time, they can pass out. Dr. Farrell says this may lead to serious injury or even death. "Certainly, when you get to the point of passing out, you've got some evidence of brain dysfunction. That's the severe danger of the game."

How Do They Play the Game?

The choking game can be played alone or in groups. "Children who play the choking game intentionally try to choke themselves or someone else with a hand, belt or other device to attain the high," said Sally Freeman, RN, MSN, NCSN, director of Children's/AISD Student Health Services. "They cut off air supply, causing hypoxia or a shortage of oxygen. It's very dangerous when a person deprives the brain of oxygen. By reducing the blood pressure, the brain basically starts an irreversible process of dying."

Who Is Playing this Dangerous Game?

  • Males are much more likely to die from the choking game than girls; 87 of the victims reported on the CDC website were boys. Dr. Farrell adds that males typically engage in more risk-associated behaviors, such as the choking game.
  • Children who might participate range in age from 7 to 21, but it is especially common in middle school and high school-aged students. Freeman says children as young as elementary school are playing, particularly if they have seen older siblings or heard them talking about it.
  • Nearly all of the children who died were playing the game alone when they died.
  • Many of the children who reported playing the game are high-achieving students and not prone to use drugs. They may want to experiment with getting high without the legal or medical risk of drugs.

Warning Signs

Dr. Farrell and Sally suggest that the following signs can indicate a child has been involved in the choking game:

  • Talking about the game, including using other names for it such as "dreamin'," "fainting game," "space monkey" and "pass out game"
  • Bloodshot eyes or eyes with tiny red dots in the whites of eyes
  • Frequent, often severe, headaches
  • Marks on the neck
  • Wearing high-necked shirts, even in warm weather
  • Disorientation after spending time alone
  • Unusual demands for privacy
  • Locked or blocked bedroom or bathroom doors
  • Ropes, scarves and belts tied to bedroom furniture, doorknobs, closet racks or found knotted on the floor
  • The unexplained presence of dog leashes, choke collars or bungee cords
  • Curiosity about asphyxiation (for example questions about "How does it feel?" or "What happens?")
  • Internet history of sites mentioning Choking Game

Devastating Consequences

According to Dr. Farrell, a child can become unconscious in a matter of seconds. Cells begin to die within three minutes of cutting off blood supply to the brain. Basic functions such as memory, balance and the central nervous system start to fail with death occurring soon after. Even if death does not result, coma, seizures and broken bones may happen.

What Should Parents Do?

"My advice to parents and caregivers is to always provide enough supervision of your kids, even adolescents," said Dr. Farrell. "It's normal to spend some time alone in their room at this age, but it shouldn't be necessary to lock doors if parents allow adequate privacy."

She continued, "You don't want to give children unnecessary information if they are not playing the choking game. However, if they are engaging in suspicious behavior, you should have a frank discussion."

Sally added, "If you believe your child is playing the choking game, speak to them about the life-threatening results that can occur, and consult a medical professional."


The Choking Game

Good Health for Kids is produced by Dell Children's Medical Center of Central Texas.