The activity commonly known as the “choking game” is a dangerous behavior observed among pre-teens and adolescents. This practice involves intentionally restricting oxygen flow to the brain, a severe form of thrill-seeking. The fatal potential of this activity necessitates immediate awareness and open discussion from parents, educators, and healthcare providers. It is a direct threat to neurological function and life.
Defining the Activity and Its Mechanism
This behavior is known by various names, including the “Blackout Game,” “Passout Challenge,” “Space Monkey,” or “Fainting Game.” The goal is to achieve a brief, temporary feeling of euphoria or a “high” resulting from a sudden lack of oxygen to the brain, known as cerebral hypoxia. This sensation occurs just before loss of consciousness and again when blood flow returns, causing a perceived “rush.”
Participants achieve this effect through two primary methods: strangulation or hyperventilation followed by compression. Strangulation involves applying pressure to the neck using hands, an arm, or a ligature like a belt, rope, or scarf. This pressure compresses the internal carotid arteries, immediately restricting the blood supply to the brain.
A secondary mechanism involves pressing on the baroreceptors in the neck, which triggers a reflex that causes blood vessels in the brain to dilate. The other common method involves hyperventilating to reduce carbon dioxide levels in the blood, followed by a sudden chest or abdominal compression, often in a “bear hug” maneuver, to induce a blackout.
Immediate and Severe Health Consequences
The perceived euphoria is actually the initial stage of brain cell death due to oxygen deprivation. Brain cells begin to be damaged when deprived of oxygen for less than a minute, and consciousness can be lost in as little as four seconds of arterial pressure restriction. Prolonged cerebral hypoxia induces rapid neuronal cell death, which is irreversible and leads to permanent loss of neurological function.
The acute medical dangers range from short-term memory loss and difficulty concentrating to severe, lifelong mental disability. A sudden, complete loss of oxygen can lead to seizures, coma, or sudden cardiac arrest. The activity can also cause vascular injuries, such as a carotid artery dissection, which may result in a stroke, sometimes delayed by days or even weeks after the initial event.
A specific risk is retinal hemorrhaging caused by the sudden increase in pressure within the veins of the head and chest. This pressure can burst tiny retinal capillaries in the eye, resulting in bleeding that causes acute vision loss or blind spots. The risk of death is especially high when the activity is performed alone using a ligature, as the individual cannot release the pressure once unconsciousness occurs.
Recognizing the Warning Signs of Involvement
Parents and caregivers should be vigilant for physical and environmental indicators of participation. Unexplained marks, bruising, or small red dots, known as petechiae, around the neck, face, or eyelids are physical signs of strangulation. An adolescent may attempt to hide these marks by consistently wearing high-necked shirts, even in warm weather.
Behavioral changes often include frequent headaches, disorientation, or grogginess after spending time alone. Environmentally, look for objects such as belts, scarves, ropes, or dog leashes tied into unusual knots or found secured to furniture like bedposts or doorknobs. Finding online search history or discussions related to the activity’s aliases is another significant warning sign.
Strategies for Prevention and Open Discussion
Initiating a conversation requires a non-judgmental and informed approach, focusing on factual dangers rather than scare tactics. Parents should emphasize that the danger lies in the physical mechanism of cutting off oxygen to the brain. Experts advise against demonstrating the physical mechanism, as this could unintentionally instruct a curious child on how to perform the activity.
Encourage open communication and listen carefully to your child’s perspective on why they or their peers might try this behavior, often related to thrill-seeking or peer pressure. If a child admits to participating, maintain a calm demeanor and immediately seek professional help. Resources include the child’s pediatrician, a school counselor, or a mental health professional who can screen for underlying risk factors and provide appropriate intervention.