The choking game has been around for decades, billed as a "safe" way to get a rush or a high from passing out. According to a new study, about 6 percent of adolescents have played it at least once. But doctors believe kids who play it may have little idea how deadly it is.
In the choking game, a person cuts off oxygen and blood flow to the brain with a towel, belt or rope, or hyperventilates until they pass out. When the blood and oxygen rush back to the brain, it creates a euphoric high.
Also called knock out, space monkey or the pass out game, the choking game can lead to brain damage, seizures and head trauma. And for some, like Erik Robinson, the game is fatal.
Erik, a 12-year-old boy from Santa Monica, Calif., loved school, baseball and being part of his Boy Scout troop. His mother, Judy Rogg, said he had lots of friends at his new middle school, one of whom taught him the choking game on the playground one afternoon in April 2010.
The day after Erik learned the game on the playground, he tried it on his own at home after school using his rope from Boy Scouts. Rogg came home and discovered him dead in their living room.
"I figure I missed him by about 10 minutes," she said.
Rogg said she had never heard of the choking game, and initially didn't believe the police and the coroner that Erik had been playing it.
"But when my 85-year-old aunt came to Erik's funeral, she said she used to play it when she was a kid," Rogg said.
Although the choking game is not new, very little research has been done to investigate how often it happens or which kids are more likely to try it. But the new study published today in the journal Pediatrics gives a snapshot of who is engaging in this risky activity.
Researchers surveyed nearly 5,400 Oregon eighth graders, and 6.1 percent reported playing the choking game at least once in their lives. Among those who had played, 64 percent had played more than once and 27 percent had done it more than five times. Boys and girls were equally likely to have participated.
The researchers found that kids who participated in the game commonly engaged in other risky health behaviors. About 16 percent of boys and 13 percent of girls who reported using alcohol, tobacco or marijuana on the health survey also reported playing the choking game. Girls who reported being sexually active were four times as likely to participate in the choking game as those who had never had sex.
Robert Nystrom, adolescent health manager at the Oregon Public Health Division and one of the study's authors, said it's significant that kids who play the choking game are also experimenting with alcohol, drugs and sex.
"Risk-taking is a part of normal adolescent development. The fact that a lot of adolescents are participating in these behaviors shouldn't surprise us," Nystrom said. "What we want to do is prevent it."
Nystrom noted that the choking game is different from autoerotic asphyxiation, where the goal of near-strangulation is sexual gratification. In the choking game, kids simply seek the rush that comes from passing out.
In 2008, the U.S. Centers for Disease Control and Prevention counted 82 deaths between 1995 and 2007 likely related to the choking game, but the numbers of children who die or suffer injury are probably underreported.
"It is important to emphasize that this can kill you the first time you do it," said Dr. Hatim Omar, chief of adolescent medicine at the University of Kentucky. "It is also practiced by 'good kids' who do not want to do drugs so they perceive that this is a 'legal' way to get high."
Even the name diminishes the serious health risks involved, doctors say, and may give kids and teens a false impression of its dangers.
"Having the word 'game' in the name works against us," Nystrom said.
To prevent injuries and deaths from the choking game, Nystrom and his colleagues said more pediatricians need to be educated about the game and its warning signs, such as bruising around the neck, headaches and bloodshot eyes.
Some school officials and parents like Rogg believe that kids should learn about the choking game in school alongside existing lessons about drugs, alcohol and safe sex.
"It's another part of the spectrum," Rogg said.
Through her organization, Erik's Cause, Rogg works with school districts in Southern California to develop school curricula and educational materials to teach children and parents that the choking game is deadly.
"If your kid doesn't know about it yet, a kid somewhere does," Rogg said. "Parents need to know about this. And kids need to really understand just what can happen to them."