Kids give us plenty of things to worry about as they mature: Will they pay enough attention in school to get into a good college? Will they choose the right friends? Will they make the right choice when faced with drugs or alcohol? Will they wait until they’re really ready to experience sex? Current attention to an ancient practice has given families something else to understand and warn children against: choking games.
Choking games, medically known as ‘voluntary asphyxia’ goes by many terms among kids. Black Hole, Black Out, Red Out, Knock Out, Flat lining, Five Minutes in Heaven, Space Monkey, Suffocation Roulette, Gasp, Tingling, are among the names used by kids in different communities. These are terms that parents and grandparents should come to know and recognize as a sign of danger.
In these games, kids physically limit oxygen to the brain, causing a brief, intense rush as the brain automatically reacts to the perceived threat by releasing specific chemicals that cause the feeling of a temporary high. Methods range from holding their breath while a peer applies pressure to the vagal nerve (similar to applying the Heimlich maneuver) to using ligatures around the neck. Analogous to the manner in which many adolescents are initiated to cigarettes or alcohol, a trusted or high status peer presents the opportunity to participate as fun or cool. A teen who does not understand the potential danger may see it as a way to achieve a legal high and gain acceptance with peers. However, like drugs, the rush or the temporary high can become addictive. And I can never repeat often enough that the part of the brain responsible for high-level decision making is not fully developed until adolescence is over! Peer pressure, poor judgment and a potential high can make risk taking hard to resist for adolescents in many circumstances .Choking games can be played alone or with peers and are believed to be almost always initiated in groups, although the availability of online information may be changing this. As bad as the group games are, the act becomes more dangerous when a child engages alone. Safety precautions fail and kids suffocate.
Adolescent males may also come to believe that that a sexual climax can be heightened by depriving their brain of oxygen. Known as ‘autoerotic asphyxiation’ this practice has been documented in medical literature since the 19th century. Sadly, most of the documented cases are based on posthumous investigations; up to 25 deaths occur each year when fail-safe mechanisms do fail and a victim is strangled.
Here’s an important point for families with young adolescents: Sexual archetypes, or lifelong preferences, are often set in adolescence as the initial objects or behaviors associated with autonomic sexual arousal become imprinted (in a manner of speaking) in a child’s developing brain. Autoerotic asphyxia can become a dangerous lifetime habit that’s difficult to break. Experts estimate that between 250 and 1200 deaths occur per year from autoerotic asphyxiation but since many cases are mistaken for suicide the real number is hard to know. Identifying and intervening in early ‘choking games’ can prevent this particular paraphilia from becoming a deadly part of a child’s sexual life.
Of course, it is highly unlikely that any adolescent will discuss any autoerotic activities with parents or grandparents. I strongly believe that parents and care takers have the obligation to check kids’ dresser drawers, book bags and other hiding places for indications of drugs, alcohol or cigarettes; similarly, plastic bags or items that can be used as a ligature should be added to this list of contraband. Any indication of children using language similar to the many names used for choking games should be a call to action. Similarly, check a child’s browser history for searches indicating interest in these issues. In any case, kids need to hear from loving adults in their lives that this “game” has potentially deadly consequences and should never be practiced. Ever.
In an article published by the American Academy of Pediatrics, pediatricians are advised that “provided with relevant information, pediatricians can identify the syndrome, demonstrate a willingness to discuss concerns about it, ameliorate distress, and possibly prevent a tragedy.” The same is true for parents and grandparents.
 Daniel D. Cowell, MD, MLS, CPHQ , Autoerotic Asphyxiation: Secret Pleasure—Lethal Outcome? PEDIATRICS Volume 124, Number 5, November 2009 pp 1319 -1325