Unintentional strangulation deaths among children and adolescents: The “choking game”

Background: The media have reported a number of deaths of early adolescents from playing the “choking game,” which is an attempt to obtain a brief euphoric state by strangling oneself using a noose or being strangled by another person. One survey indicated that 11% of youth reported playing the game. This is the first investigation of the number and characteristics of those dying due to this activity.

Methods: Using “choking game” and its aliases as search terms, we conducted a LexisNexis search of newspapers and a Google search of additional victims' names listed on choking game awareness websites to find supporting media reports. We defined a case as a death resulting from an activity described as the “choking game.” U.S. residents 5-19 years of age who died in the United States were included.

Results: We identified 82 cases, of which 69.5% occurred in 2005-2006 with the earliest occurring in 1995. Males made up 86.6% of the deaths. The age range was 6-19 years (mean = 13.3 ± 2.1). Nearly all children had been playing alone at the time of death (95.3%). Incidence did not vary by region, season, or day of week.

Conclusions: Our research suggests that the risk of dying from the "choking game" is greatest for boys in early adolescence who play alone. Health-care providers, educators, and parents should become aware of this activity and respond to warning signs related to it. Death investigators should be aware of this game as an alternative explanation for apparent suicides.