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April 16, 2012 03:20 am :: Michele Galloway went looking for her son, Connor, one morning in their Webster, N.C., home to make sure the seventh-grader hadn't overslept.
"I opened the door and I found him," Galloway said. "And he looked like he was standing up beside his bed. And I just said, 'Connor, you're awake.' And then I realized he was not awake."
<< Courtesy of the Galloway family
Connor Galloway, age 12, was found dead in his bedroom with a belt looped around his neck. Connor's friends admitted to his mother that they'd been talking about playing "the choking game."
She looked more closely. "There was a little gap between his feet and the floor," she said. "And I realized, you know, he had a belt around his neck."
The other end of Connor's belt was looped around the top of his bunk bed.
At first, police thought Connor had committed suicide, even though he was a happy, popular 12-year-old. But Connor's friends at school admitted they had all been talking about playing "the choking game."
"I kept thinking, if I pinch myself, this is not real," Galloway said. "I'm dreaming. This is not really happening."
But it was real. And Connor's parents aren't alone. Similar reports have emerged around the country, sparking alarm among doctors, parents 
and public health officials, such as Katrina Hedberg, the state epidemiologist in Oregon.
Connor and family Courtesy of the Galloway family >>
"The choking game is a strangulation activity that some kids participate in, using either their hands or something like a rope or a belt or something like that," she says.
Why? Thomas A. Andrew, New Hampshire's chief medical examiner, who has studied the trend, explains: "As the brain is deprived of oxygen, there's this sensation of lightheadedness, which is interpreted as a high. And then once the pressure is released and blood flow is restored in a fashion, they see stars and the feeling is described as a rush," he said.
According to a study Hedberg's colleagues published today in the journal Pediatrics, around 6 percent of more than 5,000 middle-schoolers surveyed in Portland, Ore., have tried the choking game. And about a quarter of them have tried it at least five times, the researchers reported.
"With each of those episodes, obviously, just a little bit of the brain is being damaged," Andrew said. "So who knows what the long-term effects may be on children who do this repeatedly?"
And no one really knows how often the game is being played or how many kids may have died. Back in 2008, a national estimate put the death toll from the choking game at about 82 between 1995 and 2007. But the study relied on media reports that couldn't be verified independently. And many deaths that weren't reported in the news could have been missed.
Cleveland pediatrician Nancy Bass, who has also studied the game, hopes the new research will help parents, doctors and teachers spot kids at risk. The survey found that despite the game's reputation as being a "good kid's high," those participating in the game also engaged in other high-risk activities, such as drug and alcohol use.
"The thing that haunts me is that every parent that I've taken care of their child that has done this did say to me, 'If I just knew. I mean, I saw hickeys or red marks on my child's neck. I saw scarfs tied around the bedpost or the closet rod being bowed,' " Bass said. "And, 'If I would have just known what that meant, I could have talked to my child and gotten them some help.' "
In hindsight, Galloway remembers telltale signs about Connor. Since he died, she has gotten involved with a group of other parents who lost children to the game, hoping her story will at least help prevent more deaths. Galloway and her husband are both teachers.
Even so, she said, "Neither one of us had never, ever heard about it before."
ONE IN 16 YOUTH PLAY THE "CHOKING GAME:" STUDY
By Genevra Pittman | Reuters
NEW YORK (Reuters Health) - In a 2009 survey of eighth graders in Oregon, one in 16 said they had participated in the "choking game," according to research published Monday.
The game -- a misnomer because of its risks, researchers say -- involves putting pressure on the neck with a towel or belt to cut off someone's oxygen supply, then releasing the pressure to give a "high" sensation.
The one-in-16 figure is in line with research from elsewhere in the United States and in other countries where youth are known to play the choking game, according to Dr. Thomas Andrew, New Hampshire's chief medical examiner.
"Of more concern in these studies that have been coming out over the last several years is that among that group... there's a smaller subset that seem to like the phenomenon enough to continue doing it on a regular basis," said Andrew, who has studied asphyxia games but wasn't involved in the new research.
Of Oregon kids who said they'd played the choking game, close to two-thirds reported having done so more than once, and more than a quarter had played at least five times.
"Some kids may experience it and say, 'This is the worst thing that's ever happened to me. I'm never going to do it again,'" Andrew told Reuters Health.
"The kids that go on to repeat it, it may not be in groups anymore. It could escalate into doing it by yourself with a ligature, and of course that's the highest risk of all."
Along with the risk of asphyxiation, the choking game comes with a chance of seizures that can cause brain damage, Andrew said. He's also seen cases of kids with fatal head injuries from when they hit the ground after their air supply was cut off.
"The more times you repeat something like this, the better the chance of a bad outcome," said Robert Nystrom, from the Oregon Public Health Division in Portland, who worked on the study.
His team's findings are based on a 2009 survey given to more than 5,000 Oregon eighth graders. The researchers found that kids who were sexually active and those who used drugs or alcohol were more likely to have played the choking game -- also known as Knock Out, Space Monkey or Flatlining -- than abstainers.
Boys and girls were equally likely to have participated.
The U.S. Centers for Disease Control and Prevention found 82 media reports of kids dying from playing the choking game from 1995 through 2007 -- but that the figure is likely an underestimate, Nystrom and his colleagues write in Pediatrics.
If a kid asphyxiates trying to get high alone, the death could look like a suicide, for example.
While groups of youth have been playing asphyxiation games for generations, researchers said they may be more dangerous and contagious now than they used to be.
"The activity itself is not new, but I think the ability to spread the word about it via the internet is adding some fuel to the fire," said W. Hobart Davies, a psychologist from the University of Wisconsin-Milwaukee who has studied the choking game but didn't participate in the new research.
"If you watched the kids doing it on YouTube, you'd think it was the most fun thing people have ever done," he told Reuters Health.
That's why the most important message is for parents and other adults who work with kids not to be afraid to bring up the choking game and its risks, researchers agreed.
"By eighth grade, kids already know. They're talking about this," Nystrom told Reuters Health.
Teaching kids and teens about the dangers of the game should be part of programs that also address drugs, alcohol and risky sexual behavior, Andrew said.
He pointed to one study that showed 40 percent of kids surveyed in Texas and Canada didn't see any danger in playing the choking game, whether or not they had ever participated themselves.
"I hope that it just becomes a part of the conversation," Andrew said.
"It's not perfectly safe, and that's the message that we need to get across."
SOURCE: http://bit.ly/jsoh2P Pediatrics, online April 16, 2012.
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