Called the choking game, the pass-out game or even California knockout, it has resurged among kids and young teens who see it on online video-sharing sites.
The choking game, in which a person uses auto-asphyxiation to pass out just for the rush of it, is not new. It's been around for years. But now kids are getting their friends to film them doing it and posting the videos on YouTube, which has breathed new life into this dangerous fad.
"I think the word 'game' sort of messed everybody up. They think it's just fun, like nothing's going to happen," said Simon Greiner, a sixth grade student from Santa Monica, Calif., who recently attended an awareness meeting run by the advocacy group Erik's Cause: Help Stop The Choking Game.
Peer pressure to try the choking game can now come from a stranger on the Internet, and curious kids can look up a variety of ways to constrict oxygen to the brain, get a quick buzz and prove to their friends that they can take on the "challenge." But several kids accidentally kill themselves in the process.
Judy Rogg launched Erik's Cause after her son Erik died two years ago from the deadly game.
"A lot of kids make it look fun," Rogg said. "They're laughing. They don't realize the kid's on the floor twitching because he's having a seizure."
"A lot of kids say, 'Well, at least we're not doing drugs,'" Rogg continued. "They think it's an alternative, and they don't understand that they're killing brain cells."
Erik was 12 years old, a Boy Scout who had just earned his Marksmanship badge, when his mother found him dead after school one day.
"He took his Boy Scout rope and made very, very intricate slip knots," basically hanging himself, Rogg said. Before her son's death she said she had never heard of the "choking game."
"The police, they said, 'This was not a suicide this was the choking game," and we looked at them and said, 'What are you talking about?" she said.
Dr. Thomas Andrew, the chief medical examiner for the state of New Hampshire, said data indicated that between 7 to 15 percent of all kids had tried some form of the choking game -- in other words, thousands of kids. Whether the method involved pressure on the neck or hyperventilation, he warned any attempt was dangerous.
"Seizures, brain damage, chronic headaches and close-head injury or death," Andrew said of the risks.
He added that the choking game should be on the radar screen of every youth mentor, scout leader, teacher, counselor and parent, because it is far from harmless fun.
Derek Gall, a high school sophomore from Randolph, Neb., said he learned the dangers of the "pass out game" the hard way when he tried it at school one day.
"I just got curious and looked up several different ways to do it. I found what seemed like the safest one to do," he said.
Gall found a video on YouTube that claimed to show a "safe" way to "pass out." The boy in the video said, "So what I'm about to show you is completely safe, don't listen to other people." He then proceeded to hyperventilate -- all caught on his webcam -- before crashing to the floor and hitting his head on furniture. The video has since been taken down by YouTube for violating their Community Guidelines .
Curious to see if it would work on himself, Gall tried the same thing at school the next day. He passed out, collapsed and smashed his head on the hard concrete floor, fracturing part of the right side of his skull.
"All I remember is standing there and then being in the nurse's office," Gall said.
"I was terrified," said his mother, Jean Gall. "If that fracture had been any deeper, he would have paralyzed his facial nerve."
Gall had to be airlifted to a regional trauma center and only later did his parents learn from hospital staff that his concussion was likely a result of the choking game. Even Gall's little sister, 12-year-old Maggie, admitted it was a popular game among some of her peers. "If they like the buzz it gives them, then they do it again and again," she said.
The Galls believe they were lucky, because their son survived. At worst, his injuries will cost him the upcoming football season. Wanting to warn other kids, Derek said, "Even if you're curious to do it, don't do it."
Maggie Gall said she partially blamed YouTube for the spread of the game. "If kids are doing stuff on the Internet that is teaching other kids to do really bad things to themselves, then YouTube should take off those videos and not allow them on anymore. ... It's not OK."
YouTube users upload 60 hours of video every minute, and the website counts on users to flag videos that break the site's rules. In a statement to "Nightline," a spokesman for YouTube said, "The safety of our users is important to us, and as such YouTube's Community Guidelines prohibit videos intended to encourage dangerous activities that risk serious physical harm. We routinely remove material according to these guidelines, and we encourage users to flag video for our attention so that we may continue to do so." YouTube removed several links provided to them by "Nightline."
"[YouTube is] making access to an incredibly dangerous practice," said advocate Judy Rogg.
No reliable national data exist as to just how many kids have lost their lives to the choking game. Rogg said statistics are scanty, in part, because there is no education about the practice and there is no death code for when kids accidentally kill themselves this way.
"They're often misclassified as suicides," she said.
Since the death of her son, Rogg has channeled her grief into action and developed a school curriculum on the choking game to spread word of its dangers to kids, parents and educators.
"It's such a silent epidemic," she said.
Rogg is currently working with schools in Southern California and hopes school districts throughout the country will start addressing the choking game, openly. Despite a number of deaths, Rogg said she is sometimes met with resistance.
"This is a very provocative topic that people are terrified to talk about," Rogg said. "It has the same stigma that trying to get drug and alcohol education into the schools had many years ago. When I went to school, they didn't teach about drugs and alcohol. And it was, 'If I tell them, they might try it.'"
Rogg said parents are fooling themselves if they think their kid doesn't know about the choking game, or won't come across other kids who do. "Even smart, strong kids make dumb choices with deadly consequences," she said.
While her son is gone, Rogg has made it her mission to make sure this deadly game won't kill someone else.
"He was on top of the world. He felt invincible. He had no clue what he was doing. He really had no clue," she said. "It kills me."