The Choking Game and Autoerotic Asphyxiation By Joseph ... - GASP

The Choking Game and Autoerotic Asphyxiation
By Joseph R. Hageman, MD, FAAP, FCCM, Your Humble Editor
The last time a dangerous “child's game” came to the attention of ICAAP pediatricians, it was a
game entitled the Chubby Bunny Game. 1 The game involves stuffing as many marshmallows into
your mouth as you can; you win if you can still say “chubby bunny.” Sadly, it came to light at the
expense of a little girl's life.
The second game came to our attention recently when a pediatrician contacted the Chapter office
to ask for information about a choking game children were playing which resulted in a euphoric
feeling. According to various educational Web sites on the topic, the teen choking game involves a
child or adolescent choking another until the child who is being choked passes out. The choked
child is supposed to experience a feeling similar to a drug-associated rush when the choking is
stopped and he or she awakens. 2 Children may play this game alone using a belt, rope, twisted
sheets or anything they can find to choke themselves. Unfortunately, the game has no guidelines
about how long to choke and, as a result, may end in death. 2,3 A variation played most frequently
by young adult males called autoerotic asphyxiation involves masturbation during choking which
results in an increased intensity of orgasm. 3,4
Who are the children participating in this activity? According to the information reviewed, they are
not “burned out” or looking for new ways to get a rush. 2,3 Participants are often not aware of the
dangers associated with these activities, but feel they are “safe.” 3 The age range of participants is
9-16 years; participants of autoerotic asphyxiation tend to be older. 1-4 Signs and symptoms seen
in children and adolescents who have participated in the choking game include:
inexplicable marks or bruises on the neck;
redness of the conjunctivae;
unexplained cuts and bruises;
locked bedroom doors;
frequent, severe headaches;
belts, leashes, ropes, ligatures and shoelaces tied in
strange knots and found in unusual locations; and/or
disorientation after spending time alone. 3
The choking game and autoerotic asphyxiation are not a new phenomenon. 1-3 Many of the papers
reviewed in the literature and referenced on Web sites were published 15-20 years ago in the

forensic medicine and/or psychiatric literature. 4-6 Families have long been frustrated with the
police, medical examiners and other physicians who decided the cause of death was suicide,
resulting in a delay before learning the true cause of death. Fortunately, it appears that a variety of
people have been working to get the word out.
Families and friends of children, adolescents and young adults that have died as a result of this
activity have been leading the way in terms of education. One Web site, www.stop-the-chokinggame.com,
was created by a victim's grandmother and includes a handout with helpful hints such
as warning signs, how to talk with participants and their families, a slide presentation which may
be downloaded for educational purposes, and a page with links and other resources. Information on
autoerotic asphyxiation can be found at www.silentvictims.org, administered by a sibling who lost
his brother to this practice. Television shows such as Oprah and Dr. Phil have also helped bring
attention to this issue.
What can we do to stop children and adolescents from playing the choking game and from
experiencing autoerotic asphyxiation? Communication and education of active and potential
participants is essential. One technique being utilized in classrooms is including a discussion of the
choking game and autoerotic asphyxiation (when age appropriate) in risky behavior programs in
school to help prevent children and adolescents from participating in these activities. Education of
families, caretakers and decision makers is also important. It is now the responsibility of medical
professionals to heighten our awareness of the choking game and autoerotic asphyxiation and
understand that these activities have never been and never will be a “game.”
Acknowledgements:
I would like to thank the following colleagues for their help: Scott Allen, ICAAP Executive Director;
Lyndi Trost, creator and administrator of stop-the-choking-game.com; and Dr. Michael Boettcher,
the pediatrician who brought the existence of the choking game to our attention. It should be
noted that as of March 2006, the national AAP had not produced official policy or guidance on this
issue, and that the above-mentioned Web sites have not been reviewed in detail or endorsed by
ICAAP.
REFERENCES
1. Hageman J. “The chubby bunny game” may be hazardous to your patients' lives. PedsCCM Web
site. Available at: http://pedsccm.wustl.edu/RARE/Chubby_bunny.html.
2. Stop the Choking Game Web site. Available at http://www.stop-the-choking-game.com.
3. Silent Victims Web site. Available at http://www.silentvictims.org.
4. Choking “Game” can kill or leave teens disabled for life [press release]. Akron: Akron Children's
Hospital; December 12, 2005.
5. ABC News. Q&A: Dangers of ‘choking games.' Available at:
http://abcnews.go.com/2020/Health/story?id=989844.