"We hope to raise awareness of the choking game among parents, health care providers and educators so they can recognize the warning signs of the activity," Toblin said.
In most cases, the researchers found, the parents of the dead children had never heard of the practice before tragedy struck. Some have since founded or joined organizations dedicated to educating other parents about the phenomenon.
The "choking game" is known by a variety of names, including "airplaning," the "blackout game," the "flatline game" and "suffocation roulette."
Among the signs that a child might be engaging in the practice, the study said, are bloodshot eyes, ligature marks on the neck, severe headaches or disorientation after spending time alone. The presence of ropes, scarves and belts tied to bedroom furniture or doorknobs, as well as the unexplained presence of dog leashes or bungee cords, might also be a tip-off.
The CDC study said the practice is a form of strangulation, either by oneself or with the assistance of others.
There are two different mechanisms used. The most common places pressure on the carotid artery in the neck, which carries blood to the brain, or on the vagus nerve, which decreases the rate and volume of blood pumped from the heart.
The second involves hyperventilation, followed by breath-holding. The practice produces a paradoxical cut in the supply of oxygen to the brain cells.
There can also be nonfatal consequences. "They can lose consciousness and kill brain cells by depriving the brain of oxygen. Permanent disability has resulted, " Toblin said.
Among the injuries are eye hemorrhages, permanent loss of short-term memory, and development of seizures or other lifelong mental disabilities.
frank.roylance@baltsun.com
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