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Deadly 'Choking Game' Still Common Among Kids

THURSDAY Jan. 14, 2010 -- As many as 6 percent of Oregon eighth-graders have tried the potentially lethal "choking game," public health officials warn in a new report.

Also known as the "blackout game," "pass-out game," "scarf game" and "space monkey," among other names, the activity involves intentionally trying to strangle oneself or another by using the hands or some sort of noose to briefly achieve a euphoric state.

But the "game" can also cause seizures, headaches, bone breaks and brain injury -- and death.

"We are just beginning to understand this behavior," said lead researcher Sarah Ramowski, an Adolescent Health Policy & Assessment Specialist in the Oregon Department of Health.

"We know that there are a significant number of kids who have participated and it has high awareness among youth -- one in three youths know about this behavior," she added.

Whether the problem is the same in other states, Ramowski would not speculate. However, early in 2008 the U.S. Centers for Disease Control and Prevention (CDC) reported 82 child and adolescent deaths between 1995 and 2007 linked to the choking game. The deaths occurred across 31 states, and included the death of an Oregon sixth-grader who fell victim to the choking game in 2006.

The new report is published in the Jan. 15 issue of the CDC journal Morbidity and Mortality Weekly Report.

For the study, Ramowski's group collected data on almost 11,000 eighth graders from 114 schools. Of these, nearly 7,800 answered a question about strangulation.

The researchers found that about one in three had heard of someone playing the choking game. In addition, almost 3 percent had helped someone and about 6 percent said they had taken part in the game.

Ramowski's group also found that children in rural areas were more likely to participate in the game than their urban counterparts.

Many children did not answer the strangulation question in the survey, however. "When we looked at kids who didn't respond to this question they were more likely to be male, they were more likely to be from rural areas -- which suggests that our rate may be an underestimate," Ramowski said.

Conventional wisdom has held that children who do not engage in other risky behaviors, such as drugs or drinking, are most likely to play the choking game.

"Our study did not find that," Ramowski said. "What we found was that kids who have engaged in this behavior are much more likely to also have engaged in other health-risk behaviors, have mental health problems, have abused substances," she said.

Ramowski believes that parents, teachers and health care workers need to know about this behavior. The choking game has been underappreciated among public health officials, she said.

"This study is the largest to date that examines the prevalence of young adolescents strangulating themselves because they think it will be fun," said Dr. Karen Sheehan, medical director of the Injury Prevention and Research Center at Children's Memorial Hospital in Chicago.

"This study confirms the smaller studies that strangulation is not a rare event. The next steps will be to find ways to effectively intervene," she said.

Another expert, Dr. Nancy Bass, an associate professor of pediatrics and neurology at Rainbow Babies and Children's Hospital at the University Hospitals Case Medical Center in Cleveland, said her research showed that few doctors knew about the "game."

Bass thinks there may be many more deaths due to the game that are classified as suicides, because the game has been thought to be the "good kids' high."

The fact that there may be more mental health risk factors involved, may be masking these deaths as suicides, "while they may be kids who are participating in this," she said.

"Pediatricians need to talk to kids about this," Bass said. "Pediatricians need to know what the warning signs are. So if you educate pediatricians and family doctors and parents, they can educate kids -- the same as drugs and everything else."

Experts say any of the following signs could indicate that your child is taking part in the choking game:

  • Unexplained marks on the neck.
  • Bloodshot eyes.
  • Ropes, scarves or belts tied to bedroom furniture or doorknobs.
  • Bent closet rods.
  • Out of place leashes or bungee cords.
  • Bleeding under the skin on the face, especially the eyelids.
  • Talking about the choking game.
  • Disorientation, especially after being alone.

More information

For more information on the "choking game," visit the U.S. Centers for Disease Control and Prevention.

Posted: January 2010


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