The Los Angeles Times “Booster Shots” blog reported that there is a game being played throughout the nation by some teenagers that involves “cutting off oxygen to the brain” to “induce a natural high.”
Although the “choking game may not be as prevalent as other [risky behaviors] like drugs,” the lead author of a paper appearing in Pediatrics points out “a seriously low level of awareness” among members of the medical community.
This raises concerns, because “a recent CDC report estimated that about 85 deaths from 1995 to 2007 were likely caused by participation in choking games, and several incidences of brain injuries have been reported,” according to a WebMD report.
But, 68 percent of the “163 pediatricians and family practitioners” who were surveyed by Rainbow Babies and Children’s Hospital researchers “had heard of the choking game, mostly through media reports.”
And, “among those who were aware of the choking game, 76% could identify at least one warning sign.”
HealthDay also covered the story.
According to the CDC report:
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. They either choke each other or use a noose to choke themselves. After just a short time, children can pass out, which may lead to serious injury or even death from hanging or strangulation.
Who is most at risk for death from playing the choking game?

• Boys were much more likely to die from the choking game than girls; 87% of victims were boys.
• Most of the children that died were 11-16 years old (89%).
• Nearly all of the children who died were playing the game alone when they died.
• Deaths have occurred all over the United States; the choking game isn’t limited to one area of the country.

What are the warning signs that a child is playing the choking game?
Parents, educators, health-care providers, or peers may observe any of the following signs that can indicate a child has been involved in the choking game:

• Discussion of the game or its aliases
• Bloodshot eyes
• Marks on the neck
• Wearing high-necked shirts, even in warm weather
• Frequent, severe headaches
• Disorientation after spending time alone
• Increased and uncharacteristic irritability or hostility
• Ropes, scarves, and belts tied to bedroom furniture or doorknobs or found knotted on the floor
• The unexplained presence of dog leashes, choke collars, bungee cords, etc.
• Petechiae (pinpoint bleeding spots) under the skin of the face, especially the eyelids, or the conjunctiva (the lining of the eyelids and eyes)

What are some of the other names used for the choking game?

• Pass-out game
• Space monkey
• Suffocation roulette
• Scarf game
• The American dream
• Fainting game
• Something dreaming game
• Purple hazing
• Blacking out/blackout
• Dream game
• Flat liner
• California choke
• Space cowboy
• Airplaning
• Purple dragon
• Cloud nine

How quickly can someone die after playing the choking game?
Someone can become unconscious in a matter of seconds. Within three minutes of continued strangulation (i.e., hanging), basic functions such as memory, balance, and the central nervous system start to fail. Death occurs shortly after.
Are there non-fatal, long-term consequences of the choking game?

• Loss of consciousness and death of brain cells due to oxygen deprivation in the brain; coma and seizures may occur in severe cases
• Concussions or broken bones (including jaws) from falls associated with the choking game
• Hemorrhages of the eye

How can the choking game be prevented?
Research is not available on the best strategies to prevent the choking game. However, parents, educators, and health-care providers should be made aware of this public health threat and the warning signs that adolescents may be playing the game.