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Choking game

Popular Choking Game Can Easily Go Very, Very Wrong

“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.”


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.

Know the names they use

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, and Tingling are among the names used by kids in different communities[1]. These are terms that parents and grandparents should come to know and recognize as a sign of danger.

Peer pressure and online resources play a role

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.

It can become addictive

Younger teens, not fully understanding 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, but it’s believed that they are 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.

It may have an autoerotic component

Adolescent males may also come to believe that that they can achieve a heightened sexual climax 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, when fail-safe mechanisms do fail and a victim is strangled.

It can become imprinted

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.

Be observant and vigilant

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.

Don’t forget their computers

Similarly, check a child’s browser history for searches that indicate interest in these issues. If this makes you feel guilty about what you may see as intrusive behavior, remember that 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.

Keep your eyes open

Don’t assume that your child understands that choking to the point of fainting is dangerous. Their peers may tell them different, and they may be more eager to give it a try than you’d ever imagine.

Choking game basics

Also called “five minutes in heaven, blackout, and the knockout challenge,” the choking game is deadly. Here’s what you need to know:

The Game: Asphyxiate your friend (or yourself) just enough to cut off the airway, until he/she feels a quick, euphoric rush.

The Catch: Sometimes the person being choked will pass out or be left with irreversible brain damage—and sometimes will even die.

Warning signs:

  • Marks and bruising around the neck (maybe they’ve newly become passionate about wearing turtlenecks or scarves)
  • Bloodshot eyes and other inexplicably chronic eye problems (caused by the force of cutting off oxygen to the brain)
  • Frequent, severe headaches
  • Uncharacteristic irritability or hostility
  • Ropes, scarves, or belts tied to strange places, such as chairs or doorknobs  

 Prevent a heartbreaking mistake

choking game
Alex Rothwell Age 13

Thirteen-year-old Alex Rothwell was at home with his mother and his younger brother when he disappeared for a while. His mother later discovered him hanging in the basement, with a dog leash around his neck. The discovery of other ligatures (strings, ropes) around the house later revealed that Alex had been playing the choking game solo—until it killed him.

Click here to read CDC info




Choking GameDr. Rosenzweig is currently Vice President, Research and Programs for Prevent Child Abuse – America, and a Lecturer at the University of Pennsylvania. She authored The Sex-Wise Parent.


[1]   Daniel D. Cowell, MD, MLS, CPHQ , Autoerotic Asphyxiation: Secret Pleasure—Lethal Outcome? PEDIATRICS Volume 124, Number 5, November 2009 pp 1319 -1325

Christine Crosby

About the author

Christine is the co-founder and editorial director for GRAND Magazine. She is the grandmother of five and great-grandmom (aka Grandmere) to one. She makes her home in St. Petersburg, Florida.

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