By Frank D. Roylance
The Baltimore Sun
Copyright 2008 The Baltimore Sun Company
BALTIMORE — Children as young as 6, looking for a free and “dreamy” high, are engaging in a potentially deadly practice many call “the choking game,” a new report says.
A federal study of news reports has identified 82 deaths in 31 states from 1995 to October 2007. Fifty-seven children died in 2005 and 2006 alone.
But even if they survive, say experts at the National Center for Injury Prevention and Control, the “game” might leave them with permanent brain damage, seizure disorders or other disabilities.
In the study reported yesterday by the U.S. Centers for Disease Control and Prevention, the greatest number of fatalities involved children ages f 11 to 16. The average age at death was 13. Eighty-seven percent were boys.
The CDC paper is the first attempt to gather national statistics on the phenomenon. The actual number of fatalities is probably higher, the scientists said, because there is no requirement that such deaths be reported as a separate category.
Intentional suicides, autoerotic activity or other questionable deaths by hanging or strangulation were not included.
In one 2006 case detailed in today’s edition of the CDC’s Morbidity and Mortality Weekly Report, a 13-year-old boy came home from school “in a good mood,” had dinner with his family and went to his bedroom to do homework.
“Approximately one hour later, his mother went to check on him and discovered him slumped in a corner with a belt tied around his neck. His face was blue,” the study said. “The mother began cardiopulmonary resuscitation while one of the other children called an ambulance. The boy died at a local hospital one hour later.”
There was no suicide note, but in the weeks that followed, “multiple teens told the director of a local counseling agency that the choking game had been played at local parties,” the report said.
One morning in April 2005, a 13-year-old girl was found hanging in her closet by a noose made from a belt and shoelace.
Her family learned later that she had been playing the choking game at school and that a group of friends had been suspended for the activity.
Although children have probably played similar “games” for generations, the study found evidence that more kids today are using ligatures - such as ropes, belts or scarves. And more are doing it alone. Both factors make the activity far more dangerous.
“Nearly all the youths who died were alone,” said Robin Toblin, the study’s lead author.
“We hope to raise awareness of the choking game among parents, health care providers and educators so they can recognize the warning signs of the activity,” Toblin said.
In most cases, the researchers found, the parents of the dead children had never heard of the practice before tragedy struck. Some have since founded or joined organizations dedicated to educating other parents about the phenomenon.
The “choking game” is known by a variety of names, including “airplaning,” the “blackout game,” the “flatline game” and “suffocation roulette.”
Among the signs that a child might be engaging in the practice, the study said, are bloodshot eyes, ligature marks on the neck, severe headaches or disorientation after spending time alone. The presence of ropes, scarves and belts tied to bedroom furniture or doorknobs, as well as the unexplained presence of dog leashes or bungee cords, might also be a tip-off.
The CDC study said the practice is a form of strangulation, either by oneself or with the assistance of others.
There are two different mechanisms used. The most common places pressure on the carotid artery in the neck, which carries blood to the brain, or on the vagus nerve, which decreases the rate and volume of blood pumped from the heart.
The second involves hyperventilation, followed by breath-holding. The practice produces a paradoxical cut in the supply of oxygen to the brain cells.
There can also be nonfatal consequences. “They can lose consciousness and kill brain cells by depriving the brain of oxygen. Permanent disability has resulted, " Toblin said.
Among the injuries are eye hemorrhages, permanent loss of short-term memory, and development of seizures or other lifelong mental disabilities.