'Choking game' worries parents

The grainy videos aren't hard to find on the Internet -- glimpses of a generations-old practice often learned in the relative privacy of a schoolyard, slumber party or summer camp.

An adolescent is hunched over, hyperventilating. Other kids push or squeeze to stop blood from flowing to the child's head and air from getting to the lungs.

The result in medical terms: self-induced hypocapnia and cerebral hypoxia. The visible result: The child's face goes blank and the body keels over, hopefully into waiting arms or onto a mattress.

"They do it, because somebody said, 'It's neat! Try it!'" said Doreen Aubel, a health teacher at Livermore's Granada High School, who teaches her students the sometimes deadly effect of the "choking game." "When we discuss it in class, and I ask how many people know someone who has played the game, a majority of hands go up."

But in-school teaching of "choking game" dangers is rare, say game experts, who hope that may change with the release this month by a Centers for Disease Control and Prevention study on "Unintentional Strangulation Deaths from the 'Choking Game' Among Youths aged 6 to 19 Years."

Aubel said players are often "risk takers, but not into substances." They are looking for a clean buzz, that brief "spacey, dreamlike feeling" without drugs.

"They know of it as a fun game, not a deadly activity," said Scott Metheny, a Pennsylvania police officer who uses his free time to visit schools around the country to speak on the subject.

"When they see their friend twitching on the floor, they think it's funny," he said. "All the kids are standing around and laughing, and they think it's safe. They don't realize the kid is having a seizure until I tell them. They don't realize that feeling they get is their brain cells dying off."

Medical reports say blocking air or blood to the head can also lead to eye hemorrhages and trigger repeated, unwanted seizures.

The CDC study examined cases in which children took the practice to the next level -- self-asphyxiation, usually done solo, with a rope, scarf, bungee cord, dog leash or other ligature. The child can easily pass out in a manner that doesn't allow them to slip out of the constricting device.

With no help near, the result is death within minutes.

Using an extensive search of media reports -- death records don't differentiate "choking game" deaths from other accidental asphyxia cases -- the CDC identified 82 deaths that likely resulted among youth 6 to 19, going back to 1995.

But both the CDC and "choking game" activists say the number is likely low, as many police investigators and medical examiners don't look for signs that such a death is anything but a suicide.

"That's a bogus number," said Sarah Pacatte, of Paradise, whose son Gabriel Harry Mordecai died playing the game in 2005.

"With suicide, it's always been 'If it looks like a suicide and smells like a suicide, it's a suicide,'" she said. "Well, how can they say that when there's no note, when they didn't give away possessions, weren't depressed and didn't show any signs? How many of those deaths really should be labeled 'undetermined?'"

She is a member of Games Adolescents Shouldn't Play, a group dedicated to raising awareness of self-choking among children. According to the group, there have been at least 306 deaths since 1995.

Both the Contra Costa and Alameda county coroner's offices are well aware of the game and look for signs.

"If there's any doubt if it's intentional or not -- and we don't just go by the manner of death -- we don't call it a suicide," said sheriff's Capt. Jon Cox of the Contra Costa Coroner's Office. "Generally, if they're thinking about getting high, they're going to have an escape. If they were standing on a bucket with a rope around their neck, obviously that's not the case."

Cox said his office has long known about it and hasn't had such a case in recent memory.

But Kim Gallagher, director of Community Against Substance Abuse in San Ramon, said that's not because kids haven't learned about the game.

"Unfortunately it's one of those secret kind of things that kids learn about at sleepovers," she said. "I haven't heard kids talking about it, but I don't believe for a second that no one is doing it."

While the CDC study found an increase in youth suffocation suicides through the mid-1990s, particularly in females, there weren't enough such cases in Alameda County to parallel that finding. Contra Costa did not have detailed enough suicide data to make a comparison.

Between 2000 and 2005, Alameda County had 19 strangulation suicides and three accidental strangulation deaths among ages 9 to 20. Those may or may not be an example of game deaths.

"We've had a few cases, but I wouldn't say it is all that prevalent," Alameda County supervising coroner Mike Yost said.

He said parents can also be in denial over the cause of their child's death.

"It's one of those things where the parents are always the last to know about what's going on, and the worst at coming up with a reason," he said, adding that medical examiners are cautious when making suicide rulings because of the stigma.