Some Docs in the Dark About Choking Game

Dec. 14, 2009 -- Nearly one-third of pediatricians are unaware of a choking game trend among adolescents, according to a new study.

Researchers say doctors who care for young people should learn to recognize warning signs and do more to educate patients about the potentially deadly game.

In the choking game, participants attempt to gain a “high” or euphoric feeling by depriving the brain of oxygen by applying pressure with another person’s hands or with belts, neckties, or other devices. Another variation involves one person taking a deep breath and holding it while a second person hugs them from behind until the first person feels dizzy and passes out.

A recent CDC report estimated that about 85 deaths from 1995 to 2007 were likely caused by participation in choking games, and several incidences of brain injuries have been reported.

Researchers say the choking game is also known by many other names, including the pass-out game, fainting game, black out, five minutes of heaven, rush, knock-out game, natural high, and suffocation roulette. It is not, however, the same as autoerotic asphyxia, the practice of using strangulation to enhance the pleasure of sexual stimulation, which is primarily practiced by adults.

In the study, published in Pediatrics, researchers look at survey results of 163 pediatricians and family practitioners about their knowledge of the choking game.

Sixty-eight percent had heard of the choking game, mostly through media reports.

Among those who were aware of the choking game, 76% could identify at least one warning sign such as:

• Strange bruising or red marks around the neck
• Bloodshot eyes
• Bed sheets, belts, T-shirts, ties, or ropes tied in strange knots and/or found in unusual places
• Visiting web sites or chat rooms mentioning asphyxiation or choking game
• Curiosity about asphyxiation (asking questions like “how does it feel?” or “what happens if...”)
• Disorientation and/or grogginess after being alone
• Locked or blocked bedroom or bathroom doors
• Frequent, often severe headaches
• Changes in attitude; becoming more aggressive
• Wear marks on furniture (bunk beds or closet rods)

The results showed that about 8% of those doctors who were aware of the choking game reported that they cared for a patient who they suspected was participating in the game.

About two-thirds of the doctors surveyed agreed that doctors should discuss the dangers of the choking game with adolescents, but only 2% reported doing so.

“To provide better care for their adolescent patients, pediatricians and family practitioners should be knowledgeable about risky behaviors encountered by their patients, including the choking game, and provide timely guidance about its dangers,” write researcher Julie L. McClave, MD, of Rainbow Babies and Children’s Hospital Case Medical Center in Cleveland, Ohio.