Choking Game: Dangerous child's play

Editor's Note: The Ohio AAP would like thank the Illinois Chapter, American
Academy of Pediatrics for its permission to publish the following article
written by ICAAP editor, Joseph R. Hageman, MD, FAAP, FCCM.

The last time a dangerous "child?s game" came to the attention of Illinois
Chapter, American Academy of Pediatrics' pediatricians, it was a game
entitled the Chubby Bunny Game. The game involves stuffing as many
marshmallows into your mouth as you can; you win if you can still say
"chubby bunny." Sadly, it came to light at the expense of a little girl's
life.

The second game came to our attention recently when a pediatrician
contacted the chapter office to ask for information about a choking game
children were playing which resulted in a euphoric feeling. According to
various educational Web sites on the topic, the Teen Choking Game involves
a child or adolescent choking another until the child who is being choked
passes out. The choked child is supposed to experience a feeling similar to
a drug-associated rush when the choking is stopped and he or she awakens.
Children may play this game alone use a belt, rope, twisted sheets or
anything they can find to choke themselves. Unfortunately, the game has no
guidelines about how long to choke and, as a result, may result in death. A
variation played most frequently by young adult males called autoerotic
asphyxiation involves masturbation during choking which results in an
increased intensity of orgasm.

Who are the children participating in this activity? According to the
information reviewed, they are not "burned out" or looking for new ways to
get a rush. Participants are often not aware of the dangers associated with
these activities, but feel they are "safe." The age range of participants is
9-16 years; participants of autoerotic asphyxiation tend to be older. Signs
and symptoms seen in children and adolescents who have participated in the
choking game include:

• inexplicable marks or bruises on the neck;
• redness of the conjunctivae;
• unexplained cuts and bruises;
• locked bedroom doors;
• frequent, severe headaches;
• belts, leashes, ropes, ligatures and shoelaces tied in strange knots and
  found in unusual locations; and/or
• disorientation after spending time alone.

The choking game and autoerotic asphyxiation are not a new phenomenon. Many
of the papers reviewed in the literature and referenced on Web sites were
published 15-20 years ago in the forensic medicine and/or psychiatric
literature. Families have long been frustrated with the police, medical
examiners and other physicians who decided the cause of death was suicide,
resulting in a delay before learning the true cause of death. Fortunately,
it appears that a variety of people have been working to get the word out.

Families and friends of children, adolescents and young adults that have
died as a result of this activity have been leading the way in terms of
education. One Web site, http://www.stop-the-choking-game.com/, was created by a
victim's grandmother and includes a handout with helpful hints such as
warning signs, how to talk with participants and their families, a slide
presentation which may be downloaded for educational purposes, and a page
with links and other resources. A father who lost his son manages another
site, http://www.teenchokinggame.com/, and sends The Teen Choking Game Newsletter free
of charge to more than 1,200 subscribers. Information on autoerotic
asphyxiation can be found at http://www.silentvictims.org/, administered by a
sibling who lost his brother to this practice. Television shows such as
Oprah and Dr. Phil have also helped bring attention to this issue
.
What can we do to stop children and adolescents from playing the choking
game and from experiencing autoerotic asphyxiation? Communication and
education of active and potential participants is essential. One technique
being utilized in classrooms is including a discussion of the choking game
and autoerotic asphyxiation (when age appropriate) in risky behavior
programs in school to help prevent children and adolescents from
participating in these activities. Education of families, caretakers and
decision-makers is also important. It is now the responsibility of medical
professionals to heighten our awareness of the choking game and autoerotic
asphyxiation and understand that these activities have never been and never
will be a "game."
  
                                                                ? Joseph R.  Hageman, MD,
                                                                  FAAP, FCCM
                                                                  Editor, Illinois Chapter, AAP

Acknowledgements:
I would like to thank the following colleagues for their help: Scott Allen,
ICAAP Executive Director; Lyndi Trost, creator and administrator of
stop-the-choking-game.com; Dan Baldwin, originator of the Teen Choking Game
Web site; and Dr. Michael Boettcher, the pediatrician who brought the
existence of the choking game to our attention. It should be noted that as
of March 2006, the national AAP had not produced official policy or guidance
on this issue, and that the above-mentioned Web sites have not been reviewed
in detail or endorsed by ICAAP.
 
References
1. Hageman J. The Chubby Bunny Game. Pediatric CCM Online Journal.1999.
http://pedsccm.wustl.edu/RARE/Chubby_bunny.html.
2. Baldwin D. The Teen Choking Game. The Teen Choking Game Email Newsletter.
2006. 
3. Trost L. Stop-the-choking-game Web site. The Links Page.
4. Turvey Brent. http://www.silentvictims.org/. June, 1995.
5. Pardi L. Akron Children?s Hospital News Release, no date.
6. Andrews Thomas. Question and answer interview about the Choking Game. ABC
News.