THURSDAY, Feb. 14 (HealthDay News) -- At least 82 youths have died from playing the "choking game" since 1995, a new government report shows.

Also known as the "blackout game," "pass out game," "scarf game," "space monkey" and other monikers, the activity involves intentionally trying to strangle oneself or another with hands or some sort of noose to briefly achieve an euphoric state.

Youth apparently hope to get a "cool and dreamy feeling" from the activity, explained Robin L. Toblin, of the National Center for Injury Prevention and Control at the U.S. Centers for Disease Control and Prevention.

"Nearly all parents whose children died were not aware of, or familiar with, this activity before the child's death, therefore it's important that parents, educators and health-care providers become aware of the choking game and learn to recognize the warning signs," Toblin said. "If parents believe their child is playing, they should speak to them about the life-threatening dangers and seek additional help if necessary."

Similar games have probably been played for generations, according to Toblin, whose report is published in the Feb. 15 issue of Morbidity and Mortality Weekly Report, a CDC publication. "What is new is that youth are playing alone and using ligatures which are risk factors that make them more likely to die from this activity," she said.

Almost 96 percent of deaths for which sufficient detail was available occurred while the youth was alone, and 93 percent of parents said they were not aware of the game until their child died.

Ligatures can include T-shirts, scarves, bungee cords, dog leashes and more, said Toblin, who spoke during a Thursday teleconference.

This report is the first attempt to measure the magnitude of the problem nationally. The only prior information on the prevalence of the game came from an Ohio youth survey, which found that 11 percent of youths aged 12 to 18 and 19 percent of youths aged 17 to 18 reported ever playing the game.

Because the choking game is not listed on death certificates or in any public health database, the CDC researchers relied on media reports since the 1970s, as well as information from two Web sites devoted to awareness of the issue. Deaths listed on a Web site were only included in the report if they were also addressed in news reports.

The earliest choking-game death was reported in the news in 1995. From 1995 to 2004, three or fewer such deaths were reported.

However, that number surged to 22 in 2005 and to 35 in 2006. For the first 10 months of 2007, the number declined again, to nine deaths. "It's not known whether fewer children are undertaking the activity or fewer media are reporting," Toblin said.

More than 86 percent of the deaths involved males, with most fatalities occurring in the 11 to 16 age range (the age range overall was 6 to 19 years, with a median age of 13).

By contrast, suicide deaths attributed to hanging/suffocation tend to increase every year and peak at the age of 19. The report did not include suicide attempts or autoerotic activity, which is considered a different behavior. It also did not include injuries from the choking game, which can include loss of consciousness, concussion, fractures, hemorrhages of the eyes, as well as permanent neurological disabilities such as seizures.

Deaths were identified in 31 states, with no geographic concentration. The report also included case studies of two individuals who had died.

The first was of a 13-year-old boy who died at a hospital one hour after his mother found him in the corner of his bedroom with a belt around his neck. After his death, teens told the director of a local counseling agency that the game had been played at local parties. The second case was that of a 13-year-old girl whose brother found her dead one morning, hanging from a belt and shoelace fashioned into a noose on the door of her bedroom closet. She had died the night before. Prior to her death, the girl had told a cousin that she had played the choking game at her school's locker room and that another group of girls at her school had been suspended for playing the game.

The warning signs that your child might be playing this game include:

• discussion of the game, including other terms for it;
• bloodshot eyes;
• marks on the neck;
• severe headaches;
• disorientation after spending time alone;
• ropes, scarves and belts tied to bedroom furniture or doorknobs or found knotted on the floor;
• unexplained presence of things like dog leashes, choke collars and bungee cords;

More information

For more on the choking game, visit Games Adolescents Shouldn't Play.

SOURCE: Feb. 14, 2008, teleconference with Robin L. Toblin, Ph.D., National Center for Injury Prevention and Control, U.S. Centers for Disease Control and Prevention; Feb. 15, 2008, Morbidity and Mortality Weekly Report

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