Return of the Choking Game: How Big a Threat Is It?

There has been extensive, mostly alarmist, coverage of the threat, but what does research say?

Concern about a potentially dangerous "choking game" among teens has surfaced once again. Sometimes kids hold their breath; sometimes they wrap a towel around their necks or hyperventilate; other times they volunteer to be choked until they black out. However it's done, it's scaring parents.

A recent ABC News story reported, "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 ... the choking game can lead to brain damage, seizures and head trauma. And for some, the game is fatal. ... The U.S. Centers for Disease Control and Prevention counted 82 deaths between 1995 and 2007 likely related to the choking game."

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The study, published in the journal Pediatrics, surveyed nearly 5,400 eighth-graders and found that 6.1 percent reported playing the choking game at least once. Another way to look at the statistic would be to note that almost all the kids in this sample (94 percent) did not play the choking game, and of those who did, only about one-quarter did it more than five times in their lives.

Though the Pediatrics study concluded that the choking game is rare among schoolkids, children have experimented with altering their states of consciousness for millennia. Kids learn from a very early age that the experience of light-headedness, confusion and disorientation can be entertaining and fun. That's why kids can often be seen spinning around in circles until they fall down, or spinning around on school-provided playground wheels. Many kids also experiment with hyperventilation to induce light-headedness.

Of course it's not just kids; teens and adults get a similar natural rush when they visit amusement park rides that spin them around and upside-down. It's all considered mostly harmless fun, though of course injuries can result from any activity; a girl who spins herself into a dizzy stupor for fun may accidentally injure herself (or another person) when she falls.

Exaggerated Threat?

There is obviously some risk to intentionally cutting off the air supply to the human body; the real question is whether or not the danger of serious injury or death because of the choking game has been exaggerated. In fact deaths and injuries from the game are very rare, and it's not particularly dangerous. Even if a person holds his or her breath to the point of losing consciousness, there's relatively little danger. Since it takes conscious effort to hold one's breath, breathing will resume once consciousness is lost. The body's autonomic nervous system kicks in and breathing resumes; that's why you cannot commit suicide by holding your breath. (Of course if a participant is hanging him- or herself - or being choked by a "friend" - that's a different matter.)

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There has been extensive, mostly alarmist, coverage of this threat, but little actual research. One study by the Centers for Disease Control and Prevention found about 82 deaths suspected of being related to the "choking game" between 1995 and 2007. Eighty-two fatalities over the course of 12 years yields about seven children killed per year. Of course those preventable deaths (technically homicides and accidental suicides) are tragic, but to put the risk in perspective, children are in far more danger from being injured or killed by hundreds of other much more common threats, including car accidents, gunshot wounds, the flu, dog bites, lightning and abusive parents. Of all the things for a parent to worry about, statistically the choking game should be near the bottom of the list.

Concerns about the hidden dangers of children's activities is nothing new. In 2009 experts worried that kids were choking themselves - not to feel light-headed but instead for sexual pleasure; according to one news report, "More children and teens than pediatricians realize could be participating in a dangerous, potentially fatal sex act known as autoerotic asphyxiation."

The following year there was widespread parental concern over "sack tapping," another dangerous (and, some claim, potentially fatal) childhood "game" in which boys slap or punch each others' testicles.

Photo: Eleven-year-old Drew Fiala is believed to have died after playing "the choking game." Credit: