Q&A: Dangers of 'Choking Games'

Aug. 3, 2005 — -- Forget drugs, forget drinking. What some kids are doing for a quick rush is shockingly stupid and extremely dangerous. They're choking themselves for fun, and some are suffering fatal consequences.

"20/20" took a look at the foolish childhood "choking game" that has led to tragic deaths of children across the country. Dr. Thomas Andrew, a pediatrician and New Hampshire's chief medical examiner, is an expert on the dangers of this high-risk game. He advises parents to talk with their kids about the dangers of "choking games." Below he answers questions from "20/20" viewers.

Julie of Farmington Hills, Mich., asks:
What is the appropriate age to talk to your child about "the choking game?" Also, how do you bring it up if they don't even know what it is? Thank you.

Dr. Andrew:
The age range most commonly involved in this behavior is 9-14. I'm not so sure they wouldn't already know something about these games. They are more common than we adults would like to believe. I would treat discussion of this like the discussion of any other high-risk behavior like smoking, alcohol and drugs. For example, when talking about drugs, you could say, "Some kids think they can 'get high' without using drugs or alcohol by hyperventilating or putting pressure on their chest or neck. This can be just as dangerous and some kids have actually died doing it."

Jennifer H. in Thibodaux asks:
This is devastating to read. As these kids are doing this, what is taking place in their bodies to make them faint? How do they think this feels good?

Dr. Andrew:
There are two parts to the experience. The first is a light-headedness (a perceived "high") due to reduced blood flow, and therefore reduced delivery of oxygen, to the brain. The second part comes with the removal of pressure on the chest or neck releasing a powerful surge of dammed up blood up through the carotid arteries into the brain (a perceived "rush"). Who knows why anyone would think this feels good?

Sharon in Toronto asks:
I've always associated such activities with the erotic asphyxiation games played by some adults. What could the motivation be in such young children? Is it also sexual arousal?

Dr. Andrew:
This activity has no sexual component and should not be confused with autoerotic asphyxia (AEA) as practiced by older, nearly exclusively male, adolescents and young adults. Asphyxial games are played by both boys and girls, most of whom are pre-pubertal or in early puberty. The primary goal is a brief, consciousness altering experience. In AEA the sexual element is primary with pornography, cross-dressing and elaborate bindings being prominent features of the scene investigation.

Anita in Minneapolis asks:
What are the long-term/short-term side effects of this "choking game" when children do it to each other (not using leashes, belts, etc.)?

Dr. Andrew:
Long-term effects have not been studied and one can only speculate what they may be. There are reports of children having sustained enough anoxic (lack of oxygen) brain damage as a result of some catastrophe playing the game to be permanently disabled. Short-term effects may still include sudden death -- even when playing with a partner or group. For example, if a player has his/her hands around a partner's neck and stimulates a small mass of nerve cells, called the carotid bodies, the heart can be brought to a virtual standstill. Other short-term effects may be traumatic injury. There have been reports of emergency room visits to repair lacerations of the scalp, sprained wrists and other injuries when a player has passed out and fallen against a piece of furniture or to the floor. One article from France describes damage to the retina in children playing what is called "the scarf game."

Deborah Lewallen in Keller, Texas, asks:
Is the "choking game" practiced by more boys than girls? What about an age range? My nephew died five years ago at age 12 from playing the choking game. He used his plastic-coated bicycle chain lock.

Dr. Andrew:
The most frequently observed age range is 9-14 and both boys and girls play. I hope your nephew's friends learned the danger of this activity and there were no other occurrences in your community. It seems to take a tragedy to focus people's attention on a particular issue of this nature.

Robert Evans in Mill Valley, Calif., asks:
Our son died this way five years ago at age 15. Until this show, we thought it must have been suicide. Where can we find out more? Are there support groups we can go to? We have carried this alone all this time blaming ourselves for not noticing something was wrong even though there were no signs of depression.
Thank you.

Dr. Andrew:
Your question is poignant in the extreme. If you have not done so and are up to it, you might consider obtaining a copy of the medical examiner or coroner's report. If the death was certified as a suicide and you have doubts based on what you have learned about this activity you may ask for a review of the case. The answer to your second question may lie in your last sentence. I know of no support groups that have coalesced around this issue. That is because your experience is likely one that others have gone through as well. With all these devastated families believing they are alone, no sharing of the experiences can occur. You may start with a suicide support group through the local chapter of the Samaritans or Compassionate Friends and as you learn more you can help others by starting your own support group.

Theresa in Palatine asks:
We had a 12-year-old son whom I found in his bedroom May 7, 2004, with the tie that he wore when he made his First Communion tied around his neck and looped around the top bunk of his bed at about 3:30 p.m. on a Friday afternoon. As if being stunned from the inevitable outcome wasn't bad enough, when we received the death certificate from the medical examiner it declared "suicide by hanging." I do believe that was harder to hear than, "we did everything we could..." Shortly afterward, we heard about this game and confronted the medical examiner, gave testimony from teachers, faith leaders and a juvenile officer. Is there any way to have his death certificate changed knowing these facts (and others I could share with you)?

Dr. Andrew:
Laws vary from state to state on the issue of appealing a ruling by the coroner or medical examiner. Ideally, any conflicts can be worked out directly with the coroner or ME, but it appears as if you have gone that route. I would respectfully suggest consultation with an attorney to at least learn if there is any formal administrative process you can go through in your state to have the case reviewed.

Lynda in Brooklyn asks:
If a child plays this game, how long could it take for them to choke to death?

Dr. Andrew:
Assuming the child is playing alone, he/she could lose consciousness within a minute after constricting the neck. Once the child loses consciousness the weight of their own body will tighten the ligature and death will occur in as little as 2 to 4 minutes.

Terri Buckley in Colfax, Wis., asks:
Are there any particular Web sites one should be looking for on a child's computer that would suggest involvement in this activity?

Dr. Andrew:
For starters, you might look for names the game is known by. Web sites with the words, "Passout," "Blackout," "Space Monkey," "Space Cowboy," "Knockout," "Gasp," "Rising Sun," "Airplaning" and others in their domain names would be suspicious. Blogs and chat rooms are also areas where this activity may be discussed.

Mary in Oil City asks:
My grandson is not playing the choking game but the game he and his friends are playing scares me as much. They hyperventilate till their arms tingle and they get light headed, then someone squeezes them so they can pass out for a few seconds. He says it's neat when this happens. What's the danger of this game?

Dr. Andrew:
This is the "old-fashioned" version of the games now played with ligatures and alone, making the "modern" version so much more dangerous. Kids have played at these kinds of game for generations, but that does not make it safe. While the risk is quite low, there is still the possibility of inducing what is called a ventricular arrhythmia (basically an electrical short-circuiting of the heart) due to the alteration in blood chemistries and oxygen content of the blood when combining hyperventilation with chest compression. I hope your grandson can be convinced to stop playing.