The February 15, 2008 issue of the Center for Disease Control and Prevention’s MMWR reports on unintentional strangulation deaths from the “Choking Game” among youth aged 6 – 19.  The report tracks reported incidents from 1995 – 2007.  What I found alarming about this report was the age of those who died – most were in middle school.

Although strangulation (self or by someone else) with hands or a noose to cause an altered state of consciousness is not a new technique, it is one that many have never heard of.  What’s new about this latest version is that children are playing alone and playing with nooses, which seem to be what is making this version fatal.  The age of those who have died suggests a lack of understanding of the consequences of restricting oxygen to their brain and putting something around their neck.

Although I do not think that schools should teach students how to engage in self-strangulation or strangulation of someone else without causing death, they can take some actions –

1)     Educate staff to look for signs that students might be engaging in this activity,

2)     Educate students’ family members about the warning signs, and

3)     Educate students about the hazards of choking someone else.

Given that the CDC data shows multiple deaths among children as young as 9 years of age, educating students about the risks should begin no later than the intermediate grades (4-6) and definitely be part of the middle school curriculum.  The education could be in the context of violence prevention and the hazards of choking someone else, rather than in the context of the game.  Discussing the game itself could lead some young people who had not heard of it to try to game.

Most parents of those who died in the study had no idea their children were engaged in the activity until the death occurred.  Warning signs include

• Talking about the game – common terms are choking game, pass-out game and space monkey
• Bloodshot eyes
• Marks on the neck
• Severe headaches
• Disorientation after spending time alone
• Ropes, scarves, and belts tied to bedroom furniture, doorknobs, or found knotted on the floor
• Unexplained presence of dog leashes, choke collars, or bungee cords
• Using the Internet to find instructions on how to practice the game.

If you have developed or found any lessons about the choking game, please post a message on this blog with information about where to find the lesson or your experience using it or what you did with young people or school staff.  In addition to the deaths, disability can result from playing the game including neurologic damage (e.g., seizures), retinal hemorrhages, and broken bones from falls due to passing out. Although the number of deaths is not large, the consequences are significant. Each death represents the waste of potential among young people who had no plans to commit suicide or murder.

Susan Wooley