Michele Mansfield didn't think twice when her 16-year-old son, Nick, asked to borrow a belt.
Little did she know that Nick wanted it so he could play the choking game, a dangerous diversion that would later kill him.
"He was smart as a whip. He could do anything, and I trusted him," Mansfield said.
In the choking game, also known as the flatliner or the pass-out game, adolescents attempt to experience a quick high -- a high that lasts only a second -- by strangling themselves. Kids commonly use belts, ropes, towels or their own hands to cut off oxygen. If the kids hold on for too long their organs begin to shut down or they are strangled to death. Some kids have reported experiencing seizures when they play.
The biggest problem about this game -- besides its potential deadliness -- is that it's fairly easy to hide. Accurate numbers on how many teens try it are hard to pin down. A New Hampshire medical examiner who handled the cases of two teens who died playing the game told the American Academy of Pediatrics that it "boggles my mind how prevalent it is."
Mansfield said that parents should keep this in mind as their children head off to summer camps. She found a photograph of her son playing the game with a friend at his church summer camp.
Mansfield, in addition to developing a Web site in memory of her son, gives presentations around the Phoenix area alerting children and their parents to the risks of playing the choking game. She believes that if she'd known about the game, her son might still be alive.
"It wasn't something that anybody had talked about or that I had heard about," Mansfield said. "Boys play it at football practice or at camps. They put down mattresses so they don't hit their heads when they fall."
The game's warning signs -- such as bloodshot eyes, frequent headaches and increased irritability -- are hard to catch, but two major camping organizations said counselors are trained to be aware of strange games kids might play.
Deron Smith, the spokesperson for the Boy Scouts of America, assures parents that although the choking game is not specifically mentioned in its programs, camp counselors know about the dangerous fad and are on the lookout for it. And Peg Smith, CEO of the American Camp Association, said parents should keep in mind that counselors are trained to be on guard for any odd behavior and suggests that if parents are concerned, they should speak to the camp directors.
There is apprehension that children who don't already know about the dangers of the choking game will only be tempted to try it after listening to presentations. Mansfield disputes this copycat theory, saying that that 70 percent to 80 percent of the children she speaks to know what the game is and how to play it before she even begins her presentation.
"They can tell me how to do it because they know how to play the game," Mansfield said. "It's not new. It's been around a long time. It's always been their little secret."
But educating kids about the choking game is not without controversy. Sue Eastgard, the executive director of the Youth Suicide Prevention Program, disagrees with Mansfield and doesn't believe parents should be explicit with children.
Eastgard said that by telling children about the choking game, presenters are only giving them more information about how to play it rather than tips on how to avoid it altogether.
"I don't think this is what kids need to hear. They need skills and alternatives they can utilize," she said.
Eastgard said children need to learn coping skills they can use when they are exposed to difficult situations like playing the choking game.
"Children are a different audience, and we have to be mindful of that," Eastgard said.