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A CUP OF HEALTH WITH CDC
The Choking Game Can Be Deadly
“Choking Game” Deaths Among Youth Aged 6–19 Years — United States, 1995–2007
February 21, 2008

[Announcer] This podcast is presented by the Centers for Disease Control and Prevention. CDC – safer,
healthier people.

[Dr. Shaw] Welcome to A Cup of Health with CDC, a weekly broadcast of the MMWR,
the Morbidity and Mortality Weekly Report. I’m Dr. Frederic Shaw, Editor of the MMWR,
and your host for this week.

It’s called the “choking game,” but it’s no game, and there are no winners. Some kids
are choking themselves or allowing a friend to choke them by hand or with some form of
noose. The intent is to get a high, caused by temporary lack of oxygen to the brain.
Tragically, this so-called ‘game’ sometimes goes too far and unintentionally results in a
death. A recent CDC survey of news reports found that, over the past 12 years, at least
82 children have died as a result of the choking game.

Dr. Robin Toblin is a researcher with CDC’s National Center for Injury Prevention and
Control. Dr. Toblin is joining us today to discuss this latest activity and steps that can be
taken to bring an end to this deadly game. Welcome to the show, Robin.

[Dr. Toblin] Thanks for having me here.

[Dr. Shaw] Robin, how did CDC first become aware of the choking game?

[Dr. Toblin] A mother of a son who died of the choking game, who’s a family practice
physician, actually wrote to the Injury Center to tell us about the phenomenon and we
hadn’t heard about it before.

[Dr. Shaw] And you followed it up from there?

[Dr. Toblin] And we followed it up from there, looking at news media reports to look for
deaths from the choking game.

[Dr. Shaw] And the goal was to find out how many cases had occurred over a period of
time?

[Dr. Toblin] That’s right. We were looking to see if a large number of children had died
from this.

[Dr. Shaw] Describe for us exactly what happens during an episode of this so-called
‘game’.

[Dr. Toblin] Well, when children play together, what they’ll do is they’ll, one of the
children will put their hands around the other child’s neck until the child passes out, and
apparently, they get a high when the blood rushes back into their head, but
unfortunately, some of the kids are playing by themselves, in their bedrooms or in the
locker rooms, and they’re using nooses, like belts or scarves, to hang themselves and
get this high. But, unfortunately, sometimes they go unconscious and they wind up
dying.

[Dr. Shaw] That’s tragic. Do you know why kids participate in this activity? Are there
suicidal intentions, or is it simply a thrill-seeking stunt?

[Dr. Toblin] From what we’ve heard from kids, is that they’re looking for just a cool and
dreamy feeling and they hear it’s fun from their friends, and so a lot of times, they’re
doing it as a social activity. And then sometimes they learn that it’s so fun, they do it by
themselves.

[Dr. Shaw] And are kids aware of the fact that it can be dangerous?

[Dr. Toblin] We don’t think a lot of the children really do know that it’s dangerous. A lot
of times, children just don’t understand how medical things work in the body, and so
they think it’s just innocent and it’s not dangerous, like drugs, like their parents have told
them about. So we don’t think a lot of them do know.

[Dr. Shaw] I understand that CDC has discovered at least 82 deaths attributed to this
‘game’ over the past 12 years. Can you describe a typical case?

[Dr. Toblin] A lot of the cases we saw happened after school or in the evenings after
school, when children were doing homework or spending time alone in their rooms, and
after not hearing any noises from the rooms, the parents would often go to the room to
check on their child and they would walk in only to find their child hanging from a door or
a bunk bed.

[Dr. Shaw] And I understand not a lot of parents knew much about the game, either.

[Dr. Toblin] Yeah, we found out that almost none of the parents of the children that died
had ever heard of the choking game before the death.

[Dr. Shaw] What are some signs that a child might be involved in the choking game?

[Dr. Toblin] Some signs to look for are red marks on the neck, frequent and severe
headaches, bloodshot eyes, and a mention of the choking game or it’s other names,
such as ‘space monkey’, ‘pass out game’, ‘flatliner’.

[Dr. Shaw] The game has many names, I understand.

[Dr. Toblin] The game has a lot of names and we actually have a list of those names on
our website.

[Dr. Shaw] Robin, do you have any recommendations for parents who suspect their
child may be participating in this activity?

[Dr. Toblin] Yeah, the most important thing is that parents, health care providers, and
educators – people that care about children – need to become aware of the choking
game and the warning signs that go along with it, and one place they can find more
information is at our website: www.cdc.gov/injury.

[Dr. Shaw] That’s it for this week’s show. Be sure to join us next week. Until then, be
well. This is Dr. Frederic Shaw for A Cup of Health with CDC

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