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CDC warns of deaths from 'choking game'

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Government health officials warned Thursday that a dangerous choking game has killed at least 82 thrill-seeking youngsters in the past dozen years, the first-ever attempt to quantify the underground practice.

Known also as “the blackout game,” “the scarf game” and “space monkey,” the self-induced strangulation claimed mostly pre-teen and teenage boys who used their hands, or, more often, belts, bungee cords or dog leashes to achieve a woozy high technically known as cerebral hypoxia.

“They hope to get a cool and dreamy feeling as they’ve described it,” said Robin L. Toblin, the lead author of the study produced by the Injury Center at the federal Centers for Disease Control and Prevention.

Toblin and others relied on news reports and choking game Web sites to analyze choking game deaths, which occurred in kids ages 6 to 19 between 1995 and 2007. Nearly 90 percent of the deaths occurred in boys; the average age was 13. No geographical patterns emerged: Choking game deaths were reported in 31 U.S. states.

Most worrisome is that more youngsters are engaging in the practice alone and when they get in trouble, there's no one to help, she added.

Underreported practice

Researchers used media reports and Web sites because there’s no reliable way to track deaths typically mischaracterized as suicides, Toblin said.  But parents who’ve lost children to the practice said it’s about time the government took a thorough and serious look at a deadly —and vastly underreported — practice.

“Acknowledgement from the CDC that this is an issue is a huge step,” said Kate Leonardi of St. Augustine, Fla., who founded the DB Foundation after her 11-year-old son, Dylan Blake, died in 2005 after playing the choking game.

“It’s been us screaming at the top of every hilltop,” she said. “The CDC attention means this is real. This isn’t grieving parents of suicidal kids.”

In fact, choking game deaths appear very different from suicides by hanging, noted Toblin. Average age of those deaths continues to climb through adolescence, while choking deaths appear to peak at 13. They also differ from "autoerotic" choking deaths, which are motivated by sexual gratification. Researchers excluded those deaths from the count.

Leonardi said she and other advocates want to see a specific code for choking game deaths added to the international mortality database to better track the problem. Dr. Len Paulozzi, a CDC medical epidemiologist, said that would have to be considered by the World Health Organization and the National Center for Health Statistics.

Reports of choking game deaths appeared to peak in 2005, when 22 deaths were reported, and in 2006, when 35 deaths were logged in news reports and Web sites, researchers found. Nine deaths occurred in the first 10 months of 2007, but researchers said they didn’t know whether the decline was because of decreased incidence or lower media interest.

It’s likely that there are about 100 U.S. choking game deaths each year, said Dr. Tom Andrew, New Hampshire’s chief medical examiner, who has been studying the phenomenon for several years.

Andrew said many coroners and medical examiners likely label the deaths as suicides because they don’t have the time or resources to interview a victim’s friends and look for alternate explanations.

Study authors said they weren’t worried that release of the report — and subsequent coverage — would prompt a spike in choking game deaths, even though youngsters typically learn about the practice through media reports.

Asphyxiation games date back decades, with waves of the fad cycling through generations.  Word spreads much faster in an era when kids can find choking game demonstrations on YouTube, Leonardi noted.

Warning signs

Researchers said the study could lead to more awareness of the problem and, perhaps, better tracking and education in the future.

“This report is an important first step in identifying the choking game as a public health problem,” said Ileana Arias, director of the Injury Center at the federal Centers for Disease Control and Prevention. “More research is needed to identify risk factors that may contribute to kids playing the choking game and to determine what may help to reduce this type of behavior.”

CDC officials warned parents and school officials to be alert for signs that kids may be engaging in the choking game, including slang references to the practice, bloodshot eyes, marks on the neck, severe headaches and disorientation after spending time alone. The unexplained presence of ropes, scarves, dog leashes, choke collars and bungee cords should also raise alarms.

Such high-level attention can only help, said Leonardi, who had never heard of the game when Dylan died by looping a nylon belt between his neck and a bedpost.

“You think your kid going into his bedroom to do his homework is perfectly safe,” she said. “I was literally 15 feet away."