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1) Quiroga, L., Ebrahim, S., Asif, M., Caffrey, J.

Dangerous games: Pool shock chemical burn to the face
(2018) JPRAS Open, 16, pp. 105-108.

Today information about fascinating chemical reactions is readily available on the internet. Unfortunately, these experiments
can have catastrophic consequences. Pool chemicals account for a significant number of injuries in the United States. Pool
Shock (calcium hypochlorite) is a powder widely used to disinfect swimming pools and has the potential to cause injury, as
described in previous studies. Here, we report a case of a young male patient with a superficial chemical burn to the face
and eyes due to a combined explosion of Pool Shock and regular Coke in a bottle. This type of chemical burn secondary to
this chemical combination has not been reported elsewhere. We discuss the chemistry involved in producing significant
inadvertent blast injury and present the management to treat these cases. © 2018 The Authors

Author Keywords
Alkaline injury; Calcium hypochlorite; Chemical burn; Explosion; Pool shock

Document Type: Article
Source: Scopus
Access Type: Open Access

2) Mukhra, R., Baryah, N., Krishan, K., Kanchan, T.

‘Blue Whale Challenge’: A Game or Crime?
(2017) Science and Engineering Ethics, pp. 1-7. Article in Press. Cited 1 time.

A bewildering range of games are emerging every other day with newer elements of fun and entertainment to woo
youngsters. Games are meant to reduce stress and enhance the cognitive development of children as well as adults.
Teenagers are always curious to indulge in newer games; and e-gaming is one such platform providing an easy access and
quicker means of entertainment. The particular game challenge which has taken the world by storm is the dangerous “Blue
Whale Challenge” often involving vulnerable teenagers. The Blue Whale Challenge is neither an application nor internet
based game but the users get a link through social media chat groups to enter this “deadly” challenge game. This probably
is the only game where the participant has to end his/her life to complete the game. The innocent teenagers are being
targeted based on their depressed psychology and are coercively isolated from their social milieux on the pretext of keeping
the challenges confidential. To add to the woes, no option is offered to quit the challenge even if the contender is unable to
complete the challenge. Blue Whale Challenge in its sheer form could be seen as an illegal, unethical and inhumane
endeavor in our present society. The present communication discusses the severe effects of the game on teenagers, the
ethical concerns involved and the preventive measures necessary to curb it. © 2017 Springer Science+Business Media
B.V., part of Springer Nature

Author Keywords
E-gaming; Entertainment; Ethics; Fear; Parental concern; Psychology; Suicides; Technology; Teenagers

Document Type: Article in Press
Source: Scopus

3) Soysal, N., Bourrat, E.

The deodorant game: A diagnostic challenge in paediatric dermatology [Le jeu du déodorant, challenge
diagnostique en dermatologie pédiatrique]
(2017) Annales de Dermatologie et de Venereologie, 144 (5), pp. 384-386.

Index Keywords
deodorant agent; dermatology, game, Letter, pediatrics

Document Type: Letter
Source: Scopus… 1/19
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4) Guilheri, J., Andronikof, A., Yazigi, L.
The “choking game”: A new craze among Brazilian children and young people. Psychophysiological, behavioral
and epidemiological characteristics of ‘asphyxial games’ [Brincadeira do desmaio: Uma nova moda mortal entre
crianças e adolescentes. Características psicofisiológicas, comportamentais e epidemiologia dos ‘jogos de
(2017) Ciencia e Saude Coletiva, 22 (3), pp. 867-878.

The ‘choking game’ is a risk-taking behavior that has spread quickly among children and young people, causing
dependence, accidents and even death, including in Brazil. These activities are performed in order to experience fleeting
euphoric sensations, attracting numerous participants through the thousands of videos posted on YouTube. The problem of
‘asphyxial games’ can be observed in the Brazilian digital media, although there is a lack of scientific studies. Through a
systematic review of the literature and complementary material, this paper aims to address the ‘asphyxial games’, warning
about the psychophysiological and behavioral effects of these practices, while also presenting international epidemiological
data. Sharing this information in academic circles is extremely important given the need to acquire more knowledge on the
topic, train professionals and propose preventive measures that raise awareness among children and young people of the
potential danger of voluntary fainting. It is equally important to raise awareness among parents and teachers so they can
identify the warning signs that children may be engaging in these practices. And finally, it is also necessary to request
government support to control exposure to videos that encourage the behavior. © 2017, Associacao Brasileira de Pos -
Graduacao em Saude Coletiva. All rights reserved.

Author Keywords
Asphyxial behaviors; Children and adolescents; Choking game; Internet; Risk behaviors

Index Keywords
accident, adolescent, adolescent behavior, airway obstruction, asphyxia, automutilation, Brazil, child, enzymology, high risk
behavior, human, Internet, psychology, statistics and numerical data; Accidents, Adolescent, Adolescent Behavior, Airway
Obstruction, Asphyxia, Brazil, Child, Humans, Internet, Risk-Taking, Self-Injurious Behavior

Document Type: Review
Source: Scopus

5) Ibrahim, A.P., Knipper, S.H., Brausch, A.M., Thorne, E.K.

Solitary participation in the "choking game" in Oregon
(2016) Pediatrics, 138 (6), art. no. e20160778, .

OBJECTIVE: The purpose of this study was to compare characteristics of youth who participate in the choking game alone
versus those who participate in a group. METHODS: Lifetime prevalence estimates were obtained from the 2011 (n = 5682)
and 2013 (n = 15 150) Oregon Healthy Teens survey. The 2011 and 2013 data sets were merged (N = 20 832) to compare
youth who participate alone versus those who participate in a group in the choking game. Multivariate modeling was
conducted to examine individual characteristics of young people who engaged in the choking game alone versus those who
engaged in the game in a group. RESULTS: In 2011, 3.8% of eighth-grade participants reported a lifetime prevalence of
choking game participation; 3.7% reported lifetime prevalence of participation in 2013. In the merged 2011/2013 data set,
17.6% (n = 93) of choking game participants indicated that they had participated alone. Compared with those who reported
participating in a group, youth who participated alone had significantly higher rates of suicide contemplation (odds ratio:
4.58; P <.001) and poor mental health (odds ratio: 2.13; P <.05). CONCLUSIONS: Youth who participate alone in the
choking game are a particularly high risk group, exhibiting substantially higher rates of suicidal ideation and poorer mental
health compared with youth who participate in the choking game in a group. Adolescent health care providers should be
aware of these associations, assess whether prevention messaging is appropriate, and be prepared to explain the high risks
of morbidity and mortality associated with participation. Copyright © 2016 by the American Academy of Pediatrics.

Index Keywords
adolescent, adolescent health, Article, attitude to health, choking game, controlled study, correlational
study, demography, female, game, geographic distribution, health hazard, health status, health survey, high risk
behavior, human, juvenile, male, mental health, Oregon, prevalence, priority journal, social participation, solitary
participation, suicidal ideation, adolescent behavior, airway obstruction, comparative
study, game, psychology, questionnaire, risk assessment, Self-Injurious Behavior; Adolescent, Adolescent Behavior, Airway
Obstruction, Female, Game Theory, Humans, Male, Oregon, Prevalence, Risk Assessment, Risk-Taking, Self-Injurious
Behavior, Suicidal Ideation, Surveys and Questionnaires

Document Type: Article
Source: Scopus

6) Mandysová, P., Boháč, M.

The “Choking Game” in the Czech Republic: An invisible phenomenon?
(2016) Kontakt, 18 (4), pp. e236-e243.

Aim The “choking game” (CG) is an activity in which self-strangulation, strangulation by others, or hyperventilation followed… 2/19
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by applied pressure to the neck or chest is used in order to restrict oxygen flow to the brain and induce a brief euphoric
state. Typically, the CG is engaged in by adolescents; it can cause serious injury and even death. The aim was to ascertain
whether there are any scholarly publications on the CG in the Czech Republic (CR) and whether Czech adolescents engage
in the CG, based on a search of sources available online. Methods Nine online databases/search engines were accessed to
identify scholarly publications on the CG in the CR, using English and Czech key words as well as the slang word “holotrop”.
Next, a Google and YouTube search was conducted to identify non-scholarly sources. The obtained sources were
systematized for qualitative analysis. Results Seven Czech scholarly publications have mentioned “self-strangulation”, a
practice sometimes used to cope with distressing emotions. Three books have described “holotropic states” (and/or
“holotropic breath work”), which are concepts and activities not identical to the CG. The Google and YouTube search
identified a plethora of Czech blogs and videos on “holotrop”, i.e. the CG. The CG has been practiced in various settings;
the motives include entertainment, peer pressure, curiosity, and a desire to overcome boredom. The bloggers have
experienced or observed diverse CG effects; their opinions on the activity vary. Conclusions We hypothesize that because
young Czechs use slang (“holotrop”) when discussing the activity, the magnitude of the problem in the CR has remained
unrecognized. Research is urgently needed to examine this phenomenon. Czech nurses should be involved in this process.
© 2016 Faculty of Health and Social Sciences of University of South Bohemia in České Budějovice

Author Keywords
Choking game; Holotrope; Self-asphyxia risk-taking behaviour; Self-strangulation; Suffocation

Document Type: Review
Source: Scopus

7) Cortey, C., Godeau, E., Ehlinger, V., Bréhin, C., Claudet, I.

Choking games among 2nd and 3rd graders [Jeux d'asphyxie chez les élèves de CE1 et CE2]
(2016) Archives de Pediatrie, 23 (1), pp. 45-52. Cited 2 times.

It is suspected that elementary school age children engage in "the choking game" or other asphyxial practices, but the
prevalence is unknown. Objective: This study was conducted to determine the prevalence among 2nd and 3rd graders.
Methods: Twenty-five schools in a region in Southeastern France were sampled on the following criteria: school size,
rural/urban location, underprivileged neighborhood or not, and private/public school. Second and third grade classes were
randomly sampled in each school. Another sample of 25 schools was selected in case a school refused to participate. A
self-administered questionnaire, previously validated in two nonsampled schools, was administered in selected classes by
the pediatrician leading the project. Results: A total of 1125 questionnaires were distributed and 95% were completed. The
mean (SD) age of children was 8.3 (0.7) years. Forty percent of children reported they had already played choking games.
Among all the declared players (n=401), the male to female ratio was 1.4; 13% of them played this game every day or
several times a day (91% were male). This prevalence varied between schools (16-75%) and games and was significantly
higher among children schooled in underprivileged neighborhoods. Seventy-six percent of non-players and 48% of players
were aware of the potential life-threatening risk. Conclusions: The mean prevalence in elementary school (40%) appears to
be higher compared to middle and high schools (5-10%). Motivation differs in elementary school children compared to older
children and teenagers. Prevention of choking games should start at elementary school and determinants leading to the
continuation of such practices from elementary school to high school need to be explored. © 2015 Elsevier Masson SAS.

Index Keywords
child, controlled study, France, high school, human, instrument validation, major clinical
study, male, motivation, neighborhood, pediatrician, prevalence, primary school, questionnaire, asphyxia, clinical
trial, female, high risk behavior, multicenter study, poverty, rural population, Self-Injurious Behavior, sex ratio, statistics and
numerical data, urban population, violence; Asphyxia, Child, Dangerous Behavior, Female, France, Humans, Male, Poverty
Areas, Prevalence, Risk-Taking, Rural Population, Self-Injurious Behavior, Sex Distribution, Surveys and
Questionnaires, Urban Population

Document Type: Article
Source: Scopus

8) Michel, G.
Psychopathology of dangerous games in young people: When pleasure is conditioned by violence and risk
[Psychopathologie des jeux dangereux chez les jeunes : Lorsque le plaisir est conditionné par la violence et le
(2015) Psychotropes (Belgium), 21 (2-3), pp. 53-72.

The phenomenon of dangerous and violent games has existed for several years among children and adolescents. In this
article we will focus on three types of games: challenge games, games of aggression and choking games. We will analyse
the psychological and psychopathological aspects of the motivations for these young players, then we will lead a discussion
on prevention. © De Boeck Supérieur. Tous droits réservés pour tous pays.

Author Keywords
Adolescence; Challenge games; Choking games; Dangerous and violent games; Prevention

Index Keywords… 3/19
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aggression, game, human, mental disease, motivation, psychological aspect, Review, violence

Document Type: Review
Source: Scopus

9) Guilheri, J., Fontan, P., Andronikof, A.

"Asphyxial games" prevalence in young teenagers: The findings of French descriptive study [Les «jeux de non-
oxygénation » chez les jeunes collégiens français: Résultats d'une étude pilote]
(2015) Neuropsychiatrie de l'Enfance et de l'Adolescence, 63 (8), pp. 495-503. Cited 1 time.

Introduction: Dangerous games and specifically fainting games like "choking game", "space monkey" and "blackout" have
become a social phenomenon among children and adolescents, be it in school or elsewhere. After a thorough review of the
literature about this category of risk-taking behaviours in children, we conducted a descriptive study aimed at investigating
the context of children's initiation in suffocation practices and the sort of games they generally prefer. Method: An ad hoc
questionnaire with 16 questions was used in a sample of 246 children, mean age 11.6 years (10-14 years) in three schools
in France. The children were also encouraged to write their personal opinion on this sort of "games". Results: Results show
that almost 1 in 4 children (n=61) had already experienced a dangerous practice of this type; age of first experience can be
as early as 4 years old; places of first experience are varied (on the streets, at home or on the Internet). Frequency of
practice goes from "2 to 3 times a month" to "every day". The preventive role of information received (mainly by the parents)
is striking: 31 % of the children who practice suffocation declare having never received any information vs. 9 % of the other
children. Conclusion: Our results show that this phenomenon is complex, probably mixing group pressures, sensation
seeking, Internet influence, negligence in education and personality factors. These results pointing a significant information
for most contribution of prevention programs. © 2015 Elsevier Masson SAS.

Author Keywords
Asphyxia; Children; Choking game; Descriptive study; Prevention; Risk behaviours; Suffocation practices; Teenagers

Index Keywords
adolescent, Article, asphyxial game, child, controlled study, descriptive
research, education, experience, France, game, health program, home, human, information
seeking, Internet, negligence, personality, practice guideline, preschool
child, prevalence, prophylaxis, questionnaire, school, school child, sensation seeking, social problem, suffocation, writing

Document Type: Article
Source: Scopus

10) Busse, H., Harrop, T., Gunnell, D., Kipping, R.

Prevalence and associated harm of engagement in self-Asphyxial behaviours ('choking game') in young people: A
systematic review
(2015) Archives of Disease in Childhood, 100 (12), pp. 1106-1114. Cited 9 times.

Objective To assess the prevalence of engagement in self-Asphyxial (risk-Taking) behaviour (SAB) ('choking game') and
associated morbidity and mortality in children and young people up to age 20. Design Systematic literature review. Search
strategy Electronic database search of MEDLINE, Embase, PsycINFO, CINAHL, PubMed, Web of Science Core Collection,
BIOSIS citation index and the Cochrane register with no language or date limits applied. References of key papers were
reviewed, and experts were contacted to identify additional relevant papers. Eligibility criteria Systematic reviews, cross-
sectional, cohort and case-control studies, and case reports examining SAB with regard to individuals aged 0-20 years,
without explicitly stated autoerotic, suicidal or self-harm intentions were included. Results Thirty-six relevant studies were
identified, and SAB was reported in 10 countries. In North America, France and Colombia, awareness of SAB ranged from
36% to 91% across studies/settings, and the median lifetime prevalence of engagement in SAB was 7.4%. Six studies
identified the potential for SAB to be associated with engagement in other risk behaviours. Ninety-nine fatal cases were
reported. Of the 24 cases described in detail, most occurred when individuals engaged in SAB alone and used a ligature.
Conclusions The current evidence on SAB among young people is limited, and stems predominantly from North America
and France. Awareness of SAB among young people is high, and engagement varies by setting. Further research is needed
to understand the level of risk and harm associated with SAB, and to determine the appropriate public health response.

Index Keywords
asphyxia, automutilation, Canada, Colombia, cross-sectional study, fatality, France, high risk
behavior, human, morbidity, mortality, North America, prevalence, priority journal, quality control, Review, risk factor, self
asphyxial behavior, systematic review, United States, adolescent, adolescent behavior, airway
obstruction, child, female, male, Self-Injurious Behavior, young adult; Adolescent, Adolescent Behavior, Airway
Obstruction, Child, Female, Humans, Male, Prevalence, Risk Factors, Risk-Taking, Self-Injurious Behavior, Young Adult

Document Type: Review
Source: Scopus… 4/19
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11) Dere, R.C., Kukde, H.G., Dhoble, S.V., Kumar, P.

Violent asphyxial death: Annual retrospective study at LTMMC & LTMGH, Sion Hospital, Mumbai
(2015) Medico-Legal Update, 15 (2), pp. 96-99.

The deaths due to asphyxia are so wide and varied that they are challenging the autopsy surgeons on many occasions.
Therefore careful study and examination of every case is important to bring wide variety of observations in death by
asphyxia. This study was aimed to evaluate pattern of violent asphyxial deaths at Department of Forensic Medicine &
Toxicology, Lokmanya Tilak Municipal Medical College & Lokmanya Tilak Municipal General Hospital, Sion, Mumbai. Total
2585 autopsies were analyzed during January 2013 to December 2013. Out of 2585 cases, 80 cases were of violent
asphyxial deaths. Majority of the cases were of male (70%) and of hanging (91.25%). © 2015, World Informations
Syndicate. All rights reserved.

Author Keywords
Choking games; Drowning; Hanging; Mugging; Pass out games; Space monkey; Strangulation; Throttling; Violent
asphyxial deaths

Index Keywords
adolescent, adult, aged, Article, asphyxia, autopsy, child, death, drowning, female, general
hospital, hanging, human, infant, injury, major clinical study, male, middle aged, newborn, preschool child, retrospective
study, school child, strangulation, throttling, very elderly, violent asphyxial death, young adult

Document Type: Article
Source: Scopus

12) Bosmia, A.N., Leon, K.J.

Lung injury and the cinnamon challenge: College students should beware this internet dare
(2015) Journal of Injury and Violence Research, 7 (1), 2 p.

Index Keywords
adverse effects, animal, Cinnamomum zeylanicum, complication, drug dependence, female, human, male, Pneumonia,
Aspiration; Animals, Cinnamomum zeylanicum, Female, Humans, Male, Pneumonia, Aspiration, Substance-Related

Document Type: Letter
Source: Scopus

13) Re, L., Birkhoff, J.M., Sozzi, M., Andrello, L., Osculati, A.M.M.
The choking game: A deadly game. Analysis of two cases of "self-strangulation" in young boys and review of the
(2015) Journal of Forensic and Legal Medicine, 30, pp. 29-33. Cited 5 times.

The choking game is defined as a self-strangulation or strangulation by another person with the hands or a noose to achieve
a brief euphoric state caused by cerebral hypoxia. Death may occur, but forensic pathologists often classify them as
suicides or accidental deaths, without focusing on the possibility that they may result from a deliberate self-temporary-
asphyxiation, turned into a deadly game. Presenting two fatal cases of self-strangulation involving an 11-year-old boy and a
teenager of 15 years, the authors identify victims' characteristics and death scene's evidence, which may help to distinguish
if a death is from an asphyxial suicide or an asphyxial game. © 2014 Elsevier Ltd and Faculty of Forensic and Legal

Author Keywords
Asphyxial game; Choking game; Jeu du foulard; Self-strangulation

Index Keywords
accidental death, adolescent, asphyxia, autopsy, bullying, case report, cause of death, child, choking
game, cyanosis, forensic pathology, game, homosexuality, human, human tissue, male, pornography, preschool
child, Review, self strangulation, strangulation, suicide, airway obstruction, automutilation, death, high risk
behavior, pathophysiology, recreation; Adolescent, Airway Obstruction, Asphyxia, Child, Death, Humans, Male, Play and
Playthings, Risk-Taking, Self-Injurious Behavior

Document Type: Review
Source: Scopus

14) Albuhairan, F., Almutairi, A., Al Eissa, M., Naeem, M., Almuneef, M.
Non-suicidal self-strangulation among adolescents in Saudi Arabia: Case series of the choking game… 5/19
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(2015) Journal of Forensic and Legal Medicine, 30, pp. 43-45. Cited 6 times.

Adolescence is known to be a time of exploration and initiation of risky behaviors. Much attention has been given to risk
behaviors such as smoking, violence, and sexual promiscuity; other serious behaviors such as self-strangulation or the
choking game, which is carried out by adolescents in response to peer pressures or to gain a transient sense of euphoria,
have received little attention, with the available literature coming from the developed world. This is the first report of cases of
non-suicidal self-strangulation from the Arab World. In this case series, we report 5 cases of non-suicidal self-strangulation
that presented to the Emergency Department of a tertiary care hospital in Riyadh, Saudi Arabia during 2010-2012. All of the
5 cases were young male adolescents aged 10-13 years. This activity resulted in the death of 2 boys; one boy sustained
hypoxic ischemic insult to the brain with clinical deficits; and the remaining 2 were fortunate to be discharged home in
healthy condition. None of the cases had underlying mental health problems, and multidisciplinary involvement ruled out
suicide and homicide activities. Non-suicidal self-strangulation is a fatal behavior that adolescents engage in. Increased
efforts are needed to address this serious and preventable public health issue. Awareness and education of adolescents
and their parents is crucial. Awareness of healthcare providers is also necessary in order to avoid misdiagnosis of such
cases. © 2015 The Authors.

Author Keywords
Adolescents; Arab World; Arabia; Choking game; Risky behaviors; Saudi; Self-strangulation

Index Keywords
adolescent, airway obstruction, Article, brain ischemia, case report, child, fatality, game, high risk
behavior, human, male, Saudi Arabia, school child, strangulation, airway
obstruction, asphyxia, automutilation, death, pathophysiology; Adolescent, Airway
Obstruction, Asphyxia, Child, Death, Humans, Male, Risk-Taking, Saudi Arabia, Self-Injurious Behavior

Document Type: Article
Source: Scopus
Access Type: Open Access

15) Grant-Alfieri, A., Schaechter, J., Lipshultz, S.E.

Ingesting and aspirating dry cinnamon by children and adolescents: The "cinnamon challenge"
(2014) Dysphagia, 29 (1), p. 114. Cited 1 time.

Index Keywords
adolescent, airway obstruction, asthma, bronchiolitis, child, cinnamon, coughing, food intake, health hazard, high risk
population, human, lung compliance, lung disease, lung fibrosis, note, priority journal, social media

Document Type: Note
Source: Scopus

16) Mechling, B., Ahern, N.R., McGuinness, T.M.

The choking game: A risky behavior for youth
(2013) Journal of Psychosocial Nursing and Mental Health Services, 51 (12), pp. 15-20. Cited 4 times.

Nurses working with children and adolescents should be cognizant of choking games, risky acts in which pressure is applied
to the neck and the airway is obstructed to achieve a high. Evidence supports that many children and adolescents do not
understand the grave consequences of choking games nor do they view participation as dangerous. Parents, teachers,
pediatricians, nurses, and psychiatric-mental health professionals are not always aware that children and adolescents are
engaging in choking games. The purpose of this article is to describe the signs, changes over the years, consequences, and
educational resources available for addressing this behavior in children and adolescents. Understanding the nomenclature
of choking games, how to assess, and how to intervene when participation in this behavior is suspected are also addressed.
© SLACK Incorporated.

Index Keywords
adolescent, adolescent behavior, airway obstruction, article, child, high risk
behavior, human, methodology, parent, psychiatric nursing, psychological aspect, violence; Adolescent, Adolescent
Behavior, Airway Obstruction, Child, Dangerous Behavior, Humans, Parents, Psychiatric Nursing, Risk-Taking

Document Type: Article
Source: Scopus

17) Roma, P., Pazzelli, F., Pompili, M., Girardi, P., Ferracuti, S.
Shibari: Double hanging during consensual sexual asphyxia
(2013) Archives of Sexual Behavior, 42 (5), pp. 895-900. Cited 3 times.

Abstract… 6/19
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We describe a case of shibari, a double hanging sexual asphyxia practice, which ended fatally for one of the two women
involved. We present the autopsy findings and a psychiatric and psychometric evaluation of the surviving participant. The
survivor had a borderline personality disorder, had suffered sexual abuse as a child, and had a history of illicit substance
consumption, self-harm behavior, and sexual dysregulation. This case study raises doubts regarding the safety measures
adopted by participants in masochistic practices and the engagement of people with psychiatric disorders in these extremely
dangerous games. Further case studies of living participants in such games are likely to shed light on this practice and
facilitate treatment. © 2012 Springer Science+Business Media New York.

Author Keywords
Autoerotic asphyxia; Forensic psychology; Paraphilias; Sadomasochism; Shibari

Index Keywords
accident, adult, asphyxia, automutilation, case report, complication, fatality, female, human, masochism, psychology, sexual
behavior, sexual deviation, survivor, article, asphyxia, masochism, psychological aspect, sexual behavior, sexual deviation;
Accidents, Adult, Asphyxia, Fatal Outcome, Female, Humans, Masochism, Paraphilias, Self-Injurious Behavior, Sexual
Behavior, Survivors; Accidents, Adult, Asphyxia, Fatal Outcome, Female, Humans, Masochism, Paraphilias, Self-Injurious
Behavior, Sexual Behavior, Survivors

Document Type: Conference Paper
Source: Scopus

18) Grant-Alfieri, A., Schaechter, J., Lipshultz, S.E.

Ingesting and aspirating dry cinnamon by children and adolescents: The "cinnamon challenge"
(2013) Pediatrics, 131 (5), pp. 833-835. Cited 4 times.

Author Keywords
Cinnamon; Particulate inhalation; Pediatrics; Respiratory effects

Index Keywords
adolescent, airway obstruction, aspiration pneumonia, asthma, bronchiolitis, burning sensation, child
behavior, cinnamon, coughing, counseling, decision making, health education, high risk
behavior, human, hypersensitivity, Internet, lung injury, nonhuman, peer pressure, poison center, priority journal, short
survey, social media

Document Type: Short Survey
Source: Scopus

19) Bernadet, S., Purper-Ouakil, D., Michel, G.

Typology of dangerous games among middle and high school students: Towards a study of the psychological
profiles [Typologie des jeux dangereux chez des collégiens : Vers une étude des profils psychologiques]
(2012) Annales Medico-Psychologiques, 170 (9), pp. 654-658. Cited 6 times.

Twelve percent of seven to 17 year-old children have been involved in a dangerous game [23]. Nowadays, it distinguishes
non-oxygenation games, aggression games and challenge games. Often mixed together, they are part of the broad
spectrum of risk taking behaviors. The objective of this research is to identify psychological factors associated with each
type of dangerous games. A multisource assessment (832 adolescents and 416 parents) found that asphyxial games could
become addictive; challenge games would be the response to a high novelty-seeking and that aggression games could be
the indicator of an emotional detachment. © 2012 Elsevier Masson SAS.

Author Keywords
Adolescence; Coping; Dangerous games; Depression; Hyperactivity; Personality

Index Keywords
adolescent, aggression, article, emotionality, game, high risk behavior, high school student, human, middle school
student, psychoanalysis, psychologic assessment, student attitude

Document Type: Article
Source: Scopus

20) Bernacki, J.M., Davies, W.H.

Prevention of the Choking Game: parent perspectives.
(2012) Journal of injury & violence research, 4 (2), pp. 73-78. Cited 9 times.

Many preadolescents and adolescents have been reported to take part in forced asphyxiation as a means of creating a
feeling of being high without taking drugs. This activity goes by different names, including the Choking Game, Blackout, and… 7/19
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Space Monkey. The limited epidemiological data suggest that about 6-11% of adolescents report having engaged in this
behavior. This study surveyed a predominantly Caucasian cohort of parents regarding their knowledge of the choking game
and its associated risks, as well as their attitudes toward possible prevention efforts. Three quarters of parents responding
reported being familiar with the choking game but considerably fewer (20%) reported having talked to their children about
this activity. Ninety-six percent of parents reported knowing that unintentional death was a potential risk and ninety percent
believe information about this activity should be included in school health curricula. Parents of adolescents in the United
States appear to be quite knowledgeable about the Choking Game and its potential risks and are overwhelmingly supportive
of prevention measures. The parents surveyed understood the importance of preventing children from engaging in the
Choking Game, but may need specific help in how to talk to their children about it. Further work is needed to confirm that the
proportion of parents identified as aware of this risk taking behavior is consistent across other populations and to urgently
identify effective prevention efforts that can be integrated into existing health curricula.

Index Keywords
adolescent, adult, article, asphyxia, automutilation, awareness, child, child behavior, child parent relation, female, high risk
behavior, human, interpersonal communication, male, middle aged, parent, psychological aspect, United States;
Adolescent, Adolescent Behavior, Adult, Asphyxia, Awareness, Child, Communication, Female, Humans, Male, Middle
Aged, Parent-Child Relations, Parents, Risk-Taking, Self-Injurious Behavior, Wisconsin, Young Adult

Document Type: Article
Source: Scopus

21) Ernoul, A., Orsat, M., Mesu, C., Garre, J.-B., Richard-Devantoy, S.
The fating game and erotic asphyxiation: From voluntary and temporary asphyxiation to addiction? [Les jeux de
non-oxygénation et l'hypoxyphilie : De l'asphyxie volontaire passagère à l'addiction ?]
(2012) Annales Medico-Psychologiques, 170 (4), pp. 231-237. Cited 3 times.

Introduction: There are two forms of voluntary and temporary asphyxiation: the " fainting game" better known as " the
choking game" , " blackout" , " space monkey" and the erotic asphyxiation. These conducts involve inducing cerebral
hypoxia with the aim of developing an altered, euphoric-like state. Unlike the choking game, erotic asphyxiation implies a
sexual activity. The objective of our work is to describe these two types of asphyxiation, which are little known by the
medical world and nevertheless responsible of numerous complications, including death. Method: We performed a
systematic review (Medline, Science Direct) between January 1988 and August 2011 to identify the frequency, as well as the
clinical and psychopathological data, and to present available ways of screening and management. Results: These
practices correspond to two different categories. The fating game of concerns teenager risk behaviors. Erotic asphyxiation is
a characteristic of young adult masochistic activity. Both of these practices pose the risk of evolving towards a behavioral
addiction. According to the model of the affective-behavioral addiction, the fainting game has an addictive potential mainly
for teenagers displaying mental and other addictive disorders. The erotic asphyxiation dependence is considered to be a
paraphiliac addiction, which also features the tolerance mechanism. Consequently, dependent subjects experience the need
to escalate exposure in order to reach the same level of pleasure. They increase the number, the time and the intensity of
hypoxia, thus heightening the risk of death and complications. A behavioral addiction is therefore regarded as a risk factor.
Conclusion: We encourage clinicians to acquaint themselves with the main alert signs (preexisting risk factors, behavior
modifications, neck erythema, unexplained somatic disorders) to screen patients for this type of conduct and to take into
account such an addictive component in clinical settings. © 2012 Elsevier Masson SAS.

Author Keywords
Addiction; Choking game; Fating game; Paraphilia; Prevention

Index Keywords
article, asphyxia, behavior change, behavior disorder, cause of death, clinical practice, erythema, high risk
behavior, human, hypoxia, masochism, mood disorder, pleasure, psychosomatic disorder, respiration control, risk
factor, screening test, sexual addiction, sexual deviation

Document Type: Article
Source: Scopus

22) Ramowski, S.K., Nystrom, R.J., Rosenberg, K.D., Gilchrist, J., Chaumeton, N.R.
Health risks of Oregon eighth-grade participants in the "choking game": Results from a population-based survey
(2012) Pediatrics, 129 (5), pp. 846-851. Cited 7 times.

OBJECTIVE: To examine the risk behaviors associated with participation in the "choking game" by eighth-graders in
Oregon. METHODS: We obtained data from the 2009 Oregon Healthy Teens survey, a cross-sectional weighted survey of
5348 eighth-graders that questioned lifetime prevalence and frequency of choking game participation. The survey also
included questions about physical and mental health, gambling, sexual activity, nutrition, physical activity/body image,
exposure to violence, and substance use. RESULTS: Lifetime prevalence of choking game participation was 6.1% for
Oregon eighth-graders, with no differences between males and females. Of the eighth-grade choking game participants,
64% had engaged in the activity more than once and 26.6% >5 times. Among males, black youth were more likely to
participate than white youth. Among both females and males, Pacific Islander youth were much more likely to participate
than white youth. Multivariate logistic regression revealed that sexual activity and substance use were significantly… 8/19
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associated with choking game participation for both males and females. CONCLUSIONS: At >6%, the prevalence of
choking game participation among Oregon youth is consistent with previous findings. However, we found that most of those
who participate will put themselves at risk more than once. Participants also have other associated health risk behaviors.
The comprehensive adolescent well visit, as recommended by the American Academy of Pediatrics, is a good opportunity
for providers to conduct a health behavior risk assessment and, if appropriate, discuss the dangers of engaging in this
activity. Copyright © 2012 by the American Academy of Pediatrics.

Author Keywords
Adolescent medicine; Adolescents; Injury prevention and control; Preventive health care visits; Risk assessment

Index Keywords
adolescent, African American, article, Asian, body image, Caucasian, child, child nutrition, choking game, controlled
study, cross-sectional study, elementary student, female, game, health hazard, high risk
behavior, Hispanic, human, male, mental health, Pacific Islander, pathological gambling, physical activity, capacity and
performance, physical constitution and health, population research, predictor variable, prevalence, priority journal, risk
assessment, risk management, school child, sexual behavior, social participation, strangulation, substance abuse, United
States, violence

Document Type: Article
Source: Scopus

23) Noirhomme-Renard, F., Gosset, C.

The "choking game" and asphyxial games: Epidemiological and clinical data [Le "jeu du foullard" etautres jeux
d'asphyxie: Données épidémiologiques et cliniques]
(2011) Revue Medicale de Liege, 66 (9), pp. 485-490. Cited 3 times.

Asphyxial games have been played by children and adolescents for generations. What seems to be more recent is an
increase in mortality linked to the increasing use of ligatures and "playing" the game alone, as reported by the media. Tthis
article summarizes the current epidemiological and clinical data on the subject.

Author Keywords
Adolescents; Asphyxial games; Choking game; Prevention; Public health

Index Keywords
airway obstruction, asphyxia, asphyxial game, choking game, clinical study, epidemiological
data, game, human, review, adolescent, airway obstruction, article, asphyxia, automutilation, child, high risk behavior;
Adolescent, Airway Obstruction, Asphyxia, Child, Humans, Risk-Taking, Self-Injurious Behavior

Document Type: Review
Source: Scopus

24) Brausch, A.M., Decker, K.M., Hadley, A.G.

Risk of suicidal ideation in adolescents with both self-asphyxial risk-taking behavior and non-suicidal self-injury
(2011) Suicide and Life-Threatening Behavior, 41 (4), pp. 424-434. Cited 15 times.

This study examined adolescent participation in self-asphyxial risk-taking behaviors (SAB), sometimes known as the
"choking game," and its relationship with other adolescent risk behaviors, including non-suicidal self-injury (NSSI).
Researchers proposed that participation in SAB and NSSI would be associated with suicidal behavior, disordered eating,
and substance use. Using a large community-based sample, results revealed preliminary associations between SAB and
other risk-taking behaviors. Adolescents who had engaged in both SAB and NSSI reported more concurrent risk behaviors
than adolescents who participated in only one of the behaviors or neither behavior. Results indicate that greater awareness
of SAB is important, and continued research can evaluate the possible link between the behavior and risk for suicide. ©
2011 The American Association of Suicidology.

Document Type: Article
Source: Scopus

25) Le Heuzey, M.-F.

Dangerous games in schoolchildren [Jeux dangereux chez l'enfant d'âge scolaire]
(2011) Archives de Pediatrie, 18 (2), pp. 235-237. Cited 5 times.

Dangerous games inside or outside school are a serious social phenomenon, but unfortunately underrecognized.
Aggressive games are a part of school bullying, which is in expansion. Choking games are very dangerous, with many… 9/19
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deaths or serious neurologic complications. Pediatricians should be knowledgeable about risky behaviors encountered by
their patients, and provide guidance about its dangers. © 2010 Elsevier Masson SAS.

Index Keywords
aggressiveness, airway obstruction, article, bullying, child, childhood mortality, game, hazard, high risk
behavior, human, neurologic disease, patient guidance, pediatrician, school, school child, social interaction;
Adolescent, Child, Child, Preschool, Dangerous Behavior, Female, Humans, Male, Play and Playthings

Document Type: Article
Source: Scopus

26) Baquero, F., Mosqueira, M., Fotheringham, M., Wahren, C., Catsicaris, C.
The choking game in adolescence, between experimentation and risk [El juego de la asfixia en la adolescencia:
Entre la experimentación y el riesgo]
(2011) Archivos Argentinos de Pediatria, 109 (1), pp. 59-61. Cited 3 times.

In the last year there was happened a series of adolescent deaths in the province of Salta that might be related to a
dangerous game known as "the choking game". It has been practiced over many years in different countries around the
world and consists of provoking brain hypoxia for some seconds by different techniques to obtain an instant of ecstasy and
pleasure. We consider relevant that health providers know about this practice and so be able to recognize through signs and
symptoms when an adolescent might be playing this game.

Author Keywords
Asphyxial games; Choking game

Index Keywords
adolescence, airway obstruction, article, brain hypoxia, child death, experimentation, game, health care
personnel, human, pleasure, risk; Adolescent, Airway Obstruction, Humans, Play and Playthings, Risk, Risk-Taking

Document Type: Article
Source: Scopus

27) Sauvageau, A.
The choking game: A misnomer
(2010) Pediatric Emergency Care, 26 (12), p. 965. Cited 5 times.

Index Keywords
airway obstruction, asphyxia, brain blood flow, disease
classification, epiglottis, hanging, human, letter, nomenclature, strangulation; Adolescent, Airway
Obstruction, Asphyxia, Child, Humans, Play and Playthings, Terminology as Topic

Document Type: Letter
Source: Scopus

28) Dake, J.A., Price, J.H., Kolm-Valdivia, N., Wielinski, M.

Association of adolescent choking game activity with selected risk behaviors
(2010) Academic Pediatrics, 10 (6), pp. 410-416. Cited 14 times.

Objective: Previous research has recommended education for parents, teachers, and anticipatory guidance by pediatricians
regarding participation in the so-called choking game, a potentially fatal behavior. The purpose of this study was to examine
possible associations between selected demographic variables and risk behaviors with youth engagement in the choking
game on the basis of secondary data analysis from a general adolescent health risk behavior survey. Methods: Self-
administered survey data from an adolescent needs assessment was used to assess choking game behavior between fall
2008 and fall 2009. The sample included 192 classrooms across 88 schools in a Midwestern state. Results: Of the 3598
questionnaires distributed to middle and high school students, 3408 (95%) were returned completed. Participation rate in the
choking game was 9%, with male participation (11%) greater than female participation (7%), and high school students (11%)
more likely than middle school students (5%) to participate. Adjusted odds ratios found that the likelihood of middle school
students engaging in the choking game were higher for older students, substance users, and those having lower grades.
For high school students, adjusted odds ratios found that being older, substance use, and selected mental health issues
(forced sex and attempted suicide) were most associated with choking activities. Conclusions: Engaging in the choking
game was highly associated with abuse of substances, suggesting that youth engage in the choking game for the thrill-
seeking experience of brief euphoria, a drug-related feeling. To reduce the potentially fatal consequences associated with
this behavior, pediatricians should screen youths and provide anticipatory guidance for higher-risk youths and their parents.
© 2010 by Academic Pediatric Association.… 10/19
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Author Keywords
Adolescent behavior; Choking; Drug usage; Injury; Mental health; Violence

Index Keywords
academic achievement, adolescent, adult, airway obstruction, article, association, child, child behavior, choking
game, female, game, groups by age, health survey, high risk behavior, high school student, human, major clinical
study, male, middle school student, prevalence, questionnaire, school child, sex difference, substance abuse, suicide
attempt, United States, violence; Adolescent, Adolescent Behavior, Age Factors, Airway
Obstruction, Child, Female, Humans, Male, Mental Disorders, Midwestern United States, Play and Playthings, Risk
Factors, Risk-Taking, Substance-Related Disorders, Violence

Document Type: Article
Source: Scopus

29) Barbería-Marcalain, E., Corrons-Perramon, J., Suelves, J.M., Alonso, S.C., Castellá-García, J., Medallo-Muñiz, J.
The choking game: A potentially lethal game [El juego de la asfixia: un juego potencialmente mortal]
(2010) Anales de Pediatria, 73 (5), pp. 264-267. Cited 9 times.

Choking games are a known behaviour among adolescents, although they have not been reported in the Spanish scientific
literature. They are games which seek a brief euphoria due to the restriction oxygen flow into the brain. The case of a 15
year-old adolescent boy who died in a room due to accidental hanging while playing the choking game is presented. Case
characteristics are described and literature reviewed. The choking game is a dangerous and potentially fatal activity. Cases
like the one described may be helpful for paediatricians and physicians in recognising this phenomenon and its risks.
Knowledge of this activity is important for the prevention and early detection of adolescents risk behaviours. © 2010
Asociación Española de Pediatría. Published by Elsevier España, S.L. All rights reserved.

Author Keywords
Asphyxia; Choking game; Forensic medicine; Injury prevention; Medico-legal autopsy; Public health; Risk behaviours

Index Keywords
accidental death, adolescent, airway obstruction, article, case report, choking game, early
diagnosis, euphoria, game, hanging, human, male, pediatrician, physician; Adolescent, Airway Obstruction, Fatal
Outcome, Humans, Male, Play and Playthings

Document Type: Article
Source: Scopus

30) Miller, M.C.

I was half listening to the television the other night and heard something about kids dying from the choking game.
What is that? How can I tell if my child might be playing this game?
(2010) The Harvard mental health letter / from Harvard Medical School, 27 (2), p. 8.

Index Keywords
airway obstruction, child, human, recreation, television; Airway Obstruction, Child, Humans, Play and
Playthings, Recreation, Television

Document Type: Article
Source: Scopus

31) Linkletter, M., Gordon, K., Dooley, J.

The choking game and you tube: A dangerous combination
(2010) Clinical Pediatrics, 49 (3), pp. 274-279. Cited 31 times.

Purpose: To study postings of partial asphyxiation by adolescents on YouTube and to increase awareness of this dangerous
activity as well as the value of YouTube as a research tool. Methods: Videos were searched on YouTube using many terms
for recreational partial asphyxiation. Data were gathered on the participants and on the occurrence of hypoxic seizure.
Results: Sixty-five videos of the asphyxiation game were identified. Most (90%) participants were male. A variety of
techniques were used. Hypoxic seizures were witnessed in 55% of videos, but occurred in 88% of videos that employed the
"sleeper hold" technique. The videos were collectively viewed 173550 times on YouTube. Conclusions: YouTube has
enabled millions of young people to watch videos of the "choking gameg" and other dangerous activities. Seeing videos may
normalize the behavior among adolescents. Increased awareness of this activity may prevent some youths from
participating and potentially harming themselves or others.

Author Keywords… 11/19
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Adolescent risk-taking; Choking game; Hypoxic seizure; Partial asphyxiation; Self-strangulation

Index Keywords
adolescent, adult, article, asphyxia, awareness, brain hypoxia, child, child behavior, female, game, human, Internet, major
clinical study, male, school child, seizure, technique, videorecording, violence, airway
obstruction, anoxia, asphyxia, automutilation, Canada, child behavior, health education, high risk behavior, information
dissemination, information processing, methodology, psychological aspect, recreation, retrospective study, seizure, sex
difference, violence; Adolescent, Adolescent Behavior, Airway Obstruction, Anoxia, Asphyxia, Canada, Child, Dangerous
Behavior, Data Collection, Female, Health Education, Humans, Information Dissemination, Internet, Male, Retrospective
Studies, Risk-Taking, Seizures, Self-Injurious Behavior, Sex Factors, Video Games, Young Adult

Document Type: Article
Source: Scopus

32) Egge, M.K., Berkowitz, C.D., Toms, C., Sathyavagiswaran, L.

The choking game: A cause of unintentional strangulation
(2010) Pediatric Emergency Care, 26 (3), pp. 206-208. Cited 22 times.

A 12-year-old girl was brought to the pediatric emergency department by ambulance after her mother found her hanging
from her bunk bed. The patient was resuscitated initially but died 5 days later after support was withdrawn. A sexual assault
examination was performed, and the finding was negative. The case was investigated as a possible homicide or suicide.
Upon questioning relatives, it was disclosed that the deceased had played the choking game. No one knew she had been
playing the game alone. The choking game is popular with adolescents and is particularly dangerous when played alone.
Emergency physicians should be aware of the characteristic warning signs that include frequent severe headaches, altered
mental status after spending time alone, neck markings, and bloodshot eyes and counsel adolescents about the real risks
associated with the activity. Accident, suicide, homicide, autoerotic behavior, and the "choking game" should be considered
in the differential when an adolescent presents with evidence of strangulation. © 2010 by Lippincott Williams & Wilkins.

Author Keywords
Accidental death; Strangulation; The choking game

Index Keywords
accidental death, adolescent, article, asphyxia, blood transfusion, brain death, case report, child behavior, emergency
ward, female, human, intensive care, play, strangulation; Accidents, Airway Obstruction, Asphyxia, Child, Fatal
Outcome, Female, Humans, Hypoxia, Brain, Recreation, Self-Injurious Behavior, Suicide

Document Type: Article
Source: Scopus

33) Erratum to 'Choking game' awareness and participation among 8th graders - Oregon, 2008 (Morbidity and Mortality
Weekly Report, (2010), 59, 1, (5))
(2010) Morbidity and Mortality Weekly Report, 59 (2), p. 49.

Document Type: Erratum
Source: Scopus

34) "Choking game" awareness and participation among 8th graders - Oregon, 2008
(2010) Morbidity and Mortality Weekly Report, 59 (1), . Cited 15 times.

Document Type: Article
Source: Scopus

35) McClave, J.L., Russell, P.J., Lyren, A., O'Riordan, M.A., Bass, N.E.
The choking game: Physician perspectives
(2010) Pediatrics, 125 (1), pp. 82-87. Cited 24 times.

OBJECTIVE: The goal was to assess awareness of the choking game among physicians who care for adolescents and to
explore their opinions regarding its inclusion in anticipatory guidance. METHODS: We surveyed 865 pediatricians and family
practitioners. The survey was designed to assess physicians' awareness of the choking game and its warning signs, the
suspected prevalence of patients' participation in the activity, and the willingness of physicians to include the choking game
in adolescent anticipatory guidance. Information on the general use of anticipatory guidance also was collected. RESULTS:
The survey was completed by 163 physicians (response rate: 21.8%). One-hundred eleven (68.1%) had heard of the… 12/19
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choking game, 68 of them (61.3%) through sources in the popular media. General pediatricians were significantly more
likely to report being aware of the choking game than were family practitioners or pediatric subspecialists (P = .004). Of
physicians who were aware of the choking game, 75.7% identified ≥1 warning sign and 52.3% identified ≥3. Only 7.6% of
physicians who were aware of the choking game reported that they cared for a patient they suspected was participating in
the activity, and 2 (1.9%) reported that they include the choking game in anticipatory guidance for adolescents. However,
64.9% of all respondents agreed that the choking game should be included in anticipatory guidance. CONCLUSIONS: Close
to one third of physicians surveyed were unaware of the choking game, a potentially life-threatening activity practiced by
adolescents. Despite acknowledging that the choking game should be included in adolescent anticipatory guidance, few
physicians reported actually discussing it. To provide better care for their adolescent patients, pediatricians and family
practitioners should be knowledgable about risky behaviors encountered by their patients, including the choking game, and
provide timely guidance about its dangers. Copyright © 2009 by the American Academy of Pediatrics.

Author Keywords
Adolescents; Anticipatory guidance; Asphyxia; Choking game; Injury prevention

Index Keywords
adolescent, adult, anticipatory guidance, child, game, general practitioner, high risk behavior, human, knowledge, patient
participation, pediatrician, physician, preschool child, prevalence, priority journal, review, school child;
Adolescent, Adolescent Behavior, Adult, Aged, Airway Obstruction, Attitude of Health Personnel, Confidence
Intervals, Counseling, Family Practice, Female, Health Care Surveys, Humans, Male, Middle Aged, Pediatrics, Physician's
Practice Patterns, Physician-Patient Relations, Probability, Risk-Taking, United States

Document Type: Review
Source: Scopus

36) Cowell, D.D.

Autoerotic asphyxiation: Secret pleasure - Lethal outcome?
(2009) Pediatrics, 124 (5), pp. 1319-1324. Cited 10 times.

OBJECTIVE: Voluntary asphyxiation among children, preteens, and adolescents by hanging or other means of inducing
hypoxia/anoxia to enhance sexual excitement is not uncommon and can lead to unintended death. This study addresses
autoerotic asphyxiation (AEA) with the intent of increasing pediatricians' knowledge of the syndrome and awareness of its
typical onset among young patients. AEA is characteristically a clandestine and elusive practice. Provided with relevant
information, pediatricians can identify the syndrome, demonstrate a willingness to discuss concerns about it, ameliorate
distress, and possibly prevent a tragedy. METHODS: A retrospective study was undertaken of published cases both fatal
and nonfatal and included personal communications, referenced citations, clinical experience, and theoretical formulations
as to causation. Characteristic AEA manifestations, prevalence, age range, methods of inducing hypoxia/anoxia, and
gender weighting are presented. All sources were used as a basis for additional considerations of etiology and possibilities
for intervention. RESULTS: AEA can be conceptualized as a personalized, ritualized, and symbolic biopsychosocial drama.
It seems to be a reenactment of intense emotional feeling-states involving an identification and sadomasochistic relationship
with a female figure. Inept AEA practitioners can miscalculate the peril of the situation that they have contrived and for
numerous reasons lose their gamble with death. CONCLUSIONS: Pediatricians should be alert to the earliest
manifestations of AEA. Awareness of choking games among the young and, of those, a subset who eventually progress to
potentially fatal AEA is strongly encouraged among all primary care professionals who may be able to interrupt the behavior.
Copyright © 2009 by the American Academy of Pediatrics.

Author Keywords
Asphyxiation; Choking games; Hypoxia/anoxia; Lethal; Masochism/sadism; Sexual stimulation; Suffocation; Suicide

Index Keywords
anoxia, article, asphyxia, autoerotic asphyxiation, awareness, behavior disorder, death, emotion, fatality, gender, general
practitioner, health care personnel, human, hypoxia, masochism, medical specialist, prevalence, priority
journal, retrospective study, sadism, sexual deviation;
Adolescent, Adult, Asphyxia, Child, Female, Humans, Male, Paraphilias

Document Type: Article
Source: Scopus

37) Romano, H.
Dangerous conduct and dangerous « games » at school [Conduites dangereuses et « jeux » dangereux à ľécole]
(2009) Psychiatrie de l'Enfant, 52 (1), pp. 247-263. Cited 4 times.

Schools are regularly confronted with the question of violence. From nursery to secondary school it can be found in various
areas : pupils against themselves, between pupils, families and teachers, but it is also visible in the violence that the school
institution shows towards its pupils as well as the professionals working there. In the past ten years, « dangerous games »
have appeared. We aim at presenting the various forms of these violent practices, better understanding their repercussions
and implementing the devices that could prevent this violence to best help the pupils concerned.… 13/19
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Author Keywords
Child; Dangerous activities; Dangerous games; Psychic suffering; School violence; Teenager

Document Type: Article
Source: Scopus

38) Romano, H.
Improving the understanding of dangerous games in a school environment [Mieux comprendre les "jeux"
dangereux en milieu scolaire]
(2009) Revue du Soignant en Sante Publique, (31), pp. 25-29. Cited 1 time.

Document Type: Article
Source: Scopus

39) Macnab, A.J., Deevska, M., Gagnon, F., Cannon, W.G., Andrew, T.
Asphyxiai games or "the choking game": A potentially fatal risk behaviour
(2009) Injury Prevention, 15 (1), pp. 45-49. Cited 25 times.

Objectives: To determine the prevalence of knowledge about and participation in asphyxiai games, sometimes called "the
choking game", and how best to raise awareness of this risk-taking behaviour and provide preventive education. Design:
Questionnaire; collaborative research model; lay advocacy group/university researchers. Setting: 8 middle and high schools
in Texas (six) and Ontario (two). A recent death from playing the choking game had occurred in one Texas school, and two
other fatalities had occurred within the state. Subjects: Students in grades 4-12, aged 9-18 years. Intervention: None.
Outcome measures: None. Results: Of 2762 surveys distributed, 2504 (90.7%) were completed. The mean (SD) age of the
responders was 13.7 (2.2) years. 68% of children had heard about the game, 45% knew somebody who played It, and 6.6%
had tried It, 93.9% of those with someone else. Forty percent of children perceived no risk. Information that playing the
game could result in death or brain damage was reported as most likely to influence behaviour. The most respected source
of a preventive education message was parents for pre-adolescents (43%) or victim/victim's family (36%) for older
adolescents. Conclusions: Knowledge of and participation in self-asphyxial behaviour is not unusual among schoolchildren.
The age of the child probably determines the best source (parents or victim/victim's family) of preventive education.

Index Keywords
adolescent, article, asphyxia, automutilation, Canada, child, clinical trial, female, high risk
behavior, human, male, multicenter study, recreation, United States;
Adolescent, Asphyxia, Child, Female, Humans, Male, Ontario, Recreation, Risk-Taking, Self-Injurious Behavior, Texas

Document Type: Article
Source: Scopus

40) Katz, K.A., Toblin, R.L.

Language matters: Unintentional strangulation, strangulation activity, and the "choking game"
(2009) Archives of Pediatrics and Adolescent Medicine, 163 (1), pp. 93-94. Cited 10 times.

Index Keywords
adolescent, airway obstruction, brain hypoxia, child behavior, choking game, game, high risk
behavior, human, letter, mortality, priority journal, strangulation; Adolescent, Airway Obstruction, Cause of
Death, Child, Euphoria, Female, Humans, Hypoxia, Brain, Incidence, Language, Male, Recreation, Risk-Taking

Document Type: Letter
Source: Scopus

41) Andrew, T.A., MacNab, A., Russell, P.

Update on "the choking game"
(2009) Journal of Pediatrics, 155 (6), pp. 777-780. Cited 18 times.

Index Keywords
adolescent, airway obstruction, article, asphyxia, child, child behavior, female, high risk
behavior, human, male, psychological aspect, recreation, United States; Adolescent, Airway
Obstruction, Asphyxia, Child, Child Behavior, Female, Humans, Male, Play and Playthings, Risk-Taking, United States

Document Type: Article… 14/19
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Source: Scopus

42) Ayadi, A., Hammami, Z., Ben Amar, W., Bardaa, S., Khemakhem, Z., Fourati, H., Maatoug, S.
The deadly fainting game among children: A case study [Le jeu de foulard mortel chez l'enfant: À propos d'un cas]
(2009) Journal de Medecine Legale Droit Medical, 52 (1-2), pp. 26-30. Cited 1 time.

The fainting game is a strangulation and choking game done alone or in a group and is becoming more and more practiced
by youths. This practice is very popular in schools. This type of game could lead to death by asphyxiation or may cause
adverse neurodevelopmental effects. In our study, we report the case of a child who died accidentally at home following
auto-strangulation while attempting the fainting game. The autopsy revealed the presence of bilateral bruising on both
faucial tonsils, in addition to Tardieu pleural spots without other pathologic lesions. The forensic diagnosis was based on the
facts and findings of the investigation. We concluded that the death was caused by mechanical asphyxiation by auto-
strangulation. The goal of this study was to draw attention to the gravity of this game that is spreading among young people.
Informative prevention programs should be put in place to reduce the expansion of this game.

Author Keywords
Asphyxiation; Auto-strangulation; Child; Fainting game

Index Keywords
article, asphyxia, autopsy, child, child death, game, home accident, human, syncope

Document Type: Article
Source: Scopus

43) Toblin, R.L., Paulozzi, L.J., Gilchrist, J., Russell, P.J.

Unintentional strangulation deaths from the "Choking Game" among youths aged 6-19 years - United States, 1995-
(2008) Journal of Safety Research, 39 (4), pp. 445-448. Cited 27 times.

The "choking game" is defined as self-strangulation or strangulation by another person with the hands or a noose to achieve
a brief euphoric state caused by cerebral hypoxia. Participants in this activity typically are youths (Andrew & Fallon, 2007).
Serious neurologic injury or death can result from engaging in this activity. Recent news media reports have described
numerous deaths among youths attributed to the choking game. Because no traditional public health dataset collects data
on this practice, CDC used news media reports to estimate the incidence of deaths from the choking game. This report
describes the results of that analysis, which identified 82 probable choking-game deaths among youths aged 6-19 years
during 1995-2007. Seventy-one (86.6%) of the decedents were male, and the mean age was 13.3 years. Parents,
educators, and health-care providers should become familiar with warning signs that youths are playing the choking game
(Urkin & Merrick, 2006). Impact of industry: By learning about the risk factors for and warning signs of the choking game,
parents, educators, and health-care providers may be able to identify youth at risk for playing the game and prevent future

Author Keywords
Adolescence; Choking game; Hanging; Risky behavior; Suffocation; Unintentional injury

Index Keywords
Health, Ketones, Risk assessment, Risk perception; Adolescence, Choking game, Hanging, Risky
behavior, Suffocation, Unintentional injury; Game theory;
accident, adolescent, adult, age, article, asphyxia, automutilation, child, child behavior, female, health survey, high risk
behavior, human, male, public health service, statistics, United States; Accidents, Adolescent, Adolescent
Behavior, Adult, Age Factors, Asphyxia, Centers for Disease Control and Prevention (U.S.), Child, Female, Health
Surveys, Humans, Male, Risk-Taking, Self-Injurious Behavior, United States

Document Type: Article
Source: Scopus

44) Ullrich, N.J., Bergin, A.M., Goodkin, H.P.

"The choking game": Self-induced hypoxia presenting as recurrent seizurelike events
(2008) Epilepsy and Behavior, 12 (3), pp. 486-488. Cited 17 times.

Risk-taking behavior resulting in accidental injury is common in adolescence. Self-induced hypoxia as a means of self-
stimulation, sometimes referred to as "the choking game," has recently become more widely recognized, particularly with a
series of well-publicized deaths in teenagers and with wider visibility on national news and Internet sites. We report a case
of self-induced hypoxia via carotid compression and breath holding that presented as recurrent confusional episodes and
seizurelike events. Video/EEG monitoring was a useful tool in elucidating the neurological effects of the "game," which may
result in prolonged neurological injury or life-threatening outcome. © 2008 Elsevier Inc. All rights reserved.… 15/19
19/06/2018 Scopus - Print - 55 (June 2018)

Author Keywords
Accidental injury; Adolescents; Choking game; Risk taking; Seizure; Self-induced hypoxia

Index Keywords
valproic acid; adolescent, article, automutilation, brain hypoxia, breath holding, carotid artery obstruction, case
report, confusion, electroencephalogram, human, limb tremor, male, monotherapy, patient monitoring, seizure;
Adolescent, Airway Obstruction, Anoxia, Electroencephalography, Humans, Male, Play and Playthings, Seizures

Document Type: Article
Source: Scopus

45) Russell, P., Paulozzi, L., Gilchrist, J., Toblin, R.

Unintentional strangulation deaths from the "choking game" among youths aged 6-19 years - United States, 1995-
(2008) Morbidity and Mortality Weekly Report, 57 (6), pp. 141-144. Cited 29 times.

Document Type: Article
Source: Scopus

46) Bour, Y.
«Dangerous Games» between teenagers: Youthful culture, school and risks [« Jeux dangereux » entre adolescents.
Culture juvénile, institution scolaire et société du risque]
(2007) Ethnologie Francaise, 37 (4), pp. 631-637. Cited 1 time.

This paper investigates the social relations of teenagers of a secondary school in France, paticularly « dangerous » and «
violent» bodily practices. Even if the playground is a cooperative and creative space for schoolfriends, we do observe
radical behaviors. Recess time is increasingly controlled by the supervisors, who multiply rules of prohibition against
physical play. Questioning the novelty of these games, as well as their connection with other bodily practices, this study
examines the relationship between contemporary adolescent life-style within the school, playground and school institution
authority as well as media debates about teenagers risks.©Presses Universitaires de France. Tous droits réservés pour tous

Author Keywords
Adolescence; Body; Play; Risk; School institution

Document Type: Article
Source: Scopus

47) Ho, L.Y., Abdelghani, W.M.

Valsalva retinopathy associated with the choking game
(2007) Seminars in Ophthalmology, 22 (2), pp. 63-65. Cited 8 times.

A 41-year-old man with high myopia presented with a central scotoma in the left eye. Initial visual acuity in the left eye was
count fingers. Color fundus photos, fluorescein/indocyanine green angiography, and optical coherence tomography of the
macula were performed showing intraretinal and subretinal hemorrhage over the macula. The patient admitted to developing
acute vision loss after holding his breath and blowing against a closed glottis to obtain a euphoric sensation. It is extremely
important to recognize this possible cause of Valsalva retinopathy due to the potentially life-threatening outcome of this
game. Copyright © Informa Healthcare.

Author Keywords
Choking game; Retina; Valsalva retinopathy

Index Keywords
fluoxetine; adult, article, case report, central scotoma, fluorescence angiography, game, human, male, myopia, optical
coherence tomography, priority journal, retina macula hemorrhage, retina macula lutea, retinopathy, Valsalva
maneuver, visual acuity, visual impairment; Adult, Airway Obstruction, Euphoria, Fundus Oculi, Humans, Male, Play and
Playthings, Retinal Diseases, Tomography, Optical Coherence, Unconsciousness, Valsalva Maneuver

Document Type: Article
Source: Scopus… 16/19
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48) Michel, G.
Dangerous and violent games in child and adolescent: the example of aggressive and self-asphyxiation games
[Les jeux dangereux et violents chez l'enfant et l'adolescent : l'exemple des jeux d'agression et de non-
(2006) Journal de Pediatrie et de Puericulture, 19 (8), pp. 304-312. Cited 9 times.

Dangerous and violent games inside or outside school are a social phenomenon in expansion. The author propose to
distinguish two categories of dangerous games: aggressive games and self-axphyxiation games. For each of them, the
author will emphasize the clinical characteristics of the children and adolescents involved, and mention possible
consequences of these pratices. Psychological and psychopathological aspects, motivations of participants, and the
different stakes of these games will be analyzed. The last part of the article is dedicated to prevention issues. © 2006
Elsevier Masson SAS. All rights reserved.

Author Keywords
Prevention; Risk taking behaviour; Self-asphyxiation games; Violent games

Index Keywords
aggression, article, asphyxia, clinical assessment, developmental stage, game, hazard, human, mental
disease, motivation, psychological aspect, recreation, victim

Document Type: Article
Source: Scopus

49) Senanayake, M.P., Chandraratne, K.A., de Silva, T.U., Weerasuriya, D.C.

The "choking game": self-strangulation with a belt and clothes rack.
(2006) The Ceylon medical journal, 51 (3), p. 120. Cited 6 times.

Index Keywords
airway obstruction, article, asphyxia, automutilation, case report, child, clothing, high risk behavior, human, male; Airway
Obstruction, Asphyxia, Child, Clothing, Humans, Male, Risk-Taking, Self-Injurious Behavior

Document Type: Article
Source: Scopus

50) Urkin, J., Merrick, J.

The choking game or suffocation roulette in adolescence
(2006) International Journal of Adolescent Medicine and Health, 18 (2), pp. 207-208. Cited 18 times.

Index Keywords
accidental death, adolescent, aggression, airway obstruction, asphyxia, awareness, brain death, community
care, concussion, disorientation, editorial, game, health care personnel, health education, health
practitioner, human, incidence, Israel, memory disorder, patient attitude, public health service, retina
hemorrhage, seizure, skin bruising, strangulation, stroke, suicide, unconsciousness, victim; Adolescent, Adolescent
Behavior, Airway Obstruction, Asphyxia, Humans, Play and Playthings, Risk, Self-Injurious Behavior

Document Type: Editorial
Source: Scopus

51) Le Heuzey, M.F.

Dangerous games at school [Attention école: Jeux dangereux]
(2003) Archives de Pediatrie, 10 (7), pp. 587-589. Cited 6 times.

Author Keywords
Accidents, psychology; Asphyxia, psychology; Child; Paraphilias, psychology; Schools

Index Keywords
accident, adolescent, asphyxia, case report, editorial, game, human, male, psychology, school, sexual deviation

Document Type: Editorial
Source: Scopus

52) Le Heuzey, M.-F.

Dangerous games at school [Les jeux dangereux à la récréation]… 17/19
19/06/2018 Scopus - Print - 55 (June 2018)
(2003) Revue du Praticien, 53 (5), pp. 469-470.

Index Keywords
adolescence, alcohol abuse, drug abuse, experimentation, human, mental disease, school, short survey, smoking;
Adolescent, Adolescent Behavior, Child, Child Behavior, Humans, Risk Factors, Substance-Related Disorders

Document Type: Short Survey
Source: Scopus

53) Shlamovitz, G.Z., Assia, A., Ben-Sira, L., Rachmel, A.

"Suffocation roulette": A case of recurrent syncope in an adolescent boy
(2003) Annals of Emergency Medicine, 41 (2), pp. 223-226. Cited 28 times.

We present the case of a 12-year-old boy admitted with a complaint of recurrent syncopal episodes. A careful history taking
revealed the cause of the syncopal episodes to be a dangerous game played by adolescents called "suffocation roulette."
We believe that recognition of this game as a possible cause of syncopal events, together with prompt educative
intervention, might prevent adolescent morbidity and mortality and also might eliminate the need for unnecessary medical

Index Keywords
anamnesis, article, asphyxia, asthma, case report, clinical feature, diagnostic
accuracy, game, human, Israel, male, mortality, patient education, priority journal, recurrent disease, risk factor, school
child, symptom, syncope

Document Type: Article
Source: Scopus

54) Gibello, B.
A new SFPEAPA group of research concerning risk behaviours and dangerous game in children, adolescents and
young adults [Nouveau groupe de recherche de la SFPEAPA sur les conduites à risque et les jeux dangereux des
enfants, adolescents et jeunes adultes]
(2003) Neuropsychiatrie de l'Enfance et de l'Adolescence, 51 (6), pp. 354-356.

Index Keywords
adaptation, automutilation, child behavior, child development, child psychiatry, disease association, game, medical
research, review, risk assessment, risk factor, suicide, violence

Document Type: Review
Source: Scopus

55) Le, D., Macnab, A.J.

Self strangulation by hanging from cloth towel dispensers in Canadian schools
(2001) Injury Prevention, 7 (3), pp. 231-233. Cited 37 times.

Objective - To investigate a local "epidemic"of incidents of strangulation by hanging from continuous cloth towels in
dispensers. Method - The coroner's office in all provinces and territories were contacted. Five cases of hanging from
continuous cloth towels in Canadian schools were identified and reviewed. Results - There were four deaths, and one near-
death, all males age 7 to 12. Two cases were attributed to a "choking game"that provides a sensation (impending loss of
consciousness) described as "cool". In three cases, the child was alone at the time. All deaths were due to strangulation
from hanging and all occurred in school washrooms. One child (playing with two friends) recovered after admission to an
intensive care unit. Towel dispensers were removed from the two index schools. In one province the Ministry of Education
encouraged removal of towel dispensers from all schools and education of students of the dangers of "choking games".
Conclusions - Thrill seeking from partial asphyxiation appears to underlie these incidents. Awareness of such cases should
prompt appropriate education strategies to highlight the serious consequences of this form of risk taking behavior in young
males. In Canada, these incidents have resulted in changes in the design of, and legislation regarding, cloth towel

Author Keywords
Asphyxia; Self inflicted; Youth

Index Keywords
article, asphyxia, automutilation, Canada, case report, child, human, male, mortality, school;
Asphyxia, Canada, Child, Humans, Male, Schools, Self-Injurious Behavior

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Document Type: Article
Source: Scopus

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