"It is important to recognize that there are some teens who are always looking for a way to find a 'high,' and approaches like this are cheap and do not involve possession of illegal substances," Myers-Walls said. "So they are hard to control, and they may seem safer and more harmless to the kids."
Some doctors were not particularly surprised by the findings -- especially since detecting the warning signs of teh activity may be difficult during a brief appointment.
"I know that the choking game exists, but with the limited time allowed for health visits, it's hard to cover all high risk behaviors," said American Academy of Pediatrics spokeswoman Dr. Alanna Levine. "That being said, it is important to touch on the subject and perhaps research such as this study will remind pediatricians to add it to the conversations."
She added that doctors and parents should not wait for warning signs to appear before discussing the dangers of the choking game with kids.
In recent years, more research has been devoted to learning more about this dangerous game. In a February 2008 article, researchers with the U.S. Centers for Disease Control and Prevention reported that the choking game had led to the death of at least 82 children and adolescents since 1995.
According to the CDC report, most of those who died were between the ages of 11 and 16. Boys are more likely to die from the choking game than girls, and nearly all who died were playing alone when they died.
The CDC suggests that doctors and parents should be on the lookout for the following warning signs that a child may be engaging in the choking game:
Discussion of the game or its aliases
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)
Mansfield said she hopes more doctors will take these warning signs to heart so more children can be protected.
"I wish that doctors would be educated about this," she said. "They need to be, because it could save a child's life."