In February 2006, an adolescent boy aged 13 years came home from school in a good mood and had dinner with his family. He then went to his bedroom to do his homework. Approximately 1 hour later, his mother went to check on him and discovered him slumped in a corner with a belt around his neck. His face was blue. 

 

The mother began cardiopulmonary resuscitation while one of the other children called an ambulance. The boy died at a local hospital 1 hour later. No suicide note was found. The county medical examiner ruled that the death resulted from accidental asphyxiation by hanging. In the weeks following his death, multiple teens told the director of a local counseling agency that the choking game had been played at local parties.

In April 2005, an adolescent girl aged 13 years was found dead, hanging from a belt and shoelace made into a noose on the door of her bedroom closet, after her brother went to her room to see why she had not come down for breakfast. No suicide note was found. The medical examiner determined that the teen had died at 9:30 p.m. the previous night. 

 

After the teen’s death, the family learned that the girl had confided in a cousin that she recently had played the choking game in the locker room at school and that a group of girls at her school had been suspended for playing the choking game.

 

Editorial Note: This report describes the first attempt to assess the national incidence of deaths amount youths resulting from the choking game. Although asphyxial games might have been placed by youths for generations, the use of a ligature (noose around neck) while playing along appears to be a new practice that can be fatal. 

 

A search of medical literature produced no mention of the choking game until 2000. Information on the prevalence of this behavior is limited to the results of the 2006 Williams County (Ohio) Youth Health Risk Behavioral Survey, which included a question on the choking game. 

 

In that survey, 11% of youths aged 12-18 years, and 19% of youths aged 17-18 years reported ever playing the choking game. In this study, few of the parents of children who died had been familiar with the choking game.

 

Parents, educators, and health care providers should learn about the choking game and be able to recognize any of the following warning signs in youths; mention of the choking game (or the game by its other names); bloodshot eyes; marks on the neck; frequent, severe headaches; disorientation after spending time along; and ropes, scarves, and belts tied to bedroom furniture or doorknobs or found knotted on the floor.

 

Medical examiners and coroners should be aware of the choking game as a possible explanation for deaths from self-inflicted strangulation in this age group that otherwise might be mis-categorized as suicides.  In addition, better mortality surveillance is needed, and more research should be conducted (e.g., questions on youth behavior surveys regarding awareness of and involvement in the choking game) to determine prevalence, risk factors, and protective factors that will lead to effective interventions aimed at reducing or eliminating choking game participation and deaths.

Dr. Peterson is a doctor of Family and Community Medicine at the Walter L. Aument Family Health Center, 317 S. Chestnut St., Quarryville.