Kids are learning about the terrifying self-strangulation activity from social media and YouTube. Here's what you can do to keep your child safe.
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Tween Girl Texting On Bed
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Unintentional injury is the leading cause of death in children, adolescents, and young adults in the U.S. One phenomenon that's contributing to this terrifying trend is "The Choking Game," also referred to as the "pass out challenge" and a bevy of other names from "space monkey" to the "fainting game." In order to achieve a high, kids use ropes, scarves, or other items to strangle themselves, either alone or in a group.

In addition to resulting in a coma, possible brain damage, broken bones, and hemorrhages of the eye, the activity can lead to death. In fact, the Choking Game was deemed responsible for the deaths of 82 children aged 6-19 between 1995-2007, the most recent year with data available, according to the Centers for Disease Control and Prevention (CDC). But with the prevalence and popularity of social media and YouTube videos has come even more concern around the phenomenon, given the sheer number of posts and clips created by kids trying auto-asphyxiation.

Here's what every parent needs to know about the troubling phenomenon.

How Kids Learn About the Choking Game

Although the CDC no longer tracks data directly related to the Choking Game, their annual Youth Risk Behavior Surveillance System notes that five states added questions about the Choking Game to their risk assessments between 2008 and 2017. What they found was that many middle schoolers are aware of it or have played it. In 2008, about 36% of eighth graders in Oregon said they were aware of the game, and 6% said they had played it. In Kentucky, Montana, Florida and Utah, 7 to 10% of students said they had either been choked by someone or purposely tried to choke themselves for the feeling or experience it caused.

It's easy to draw a parallel between these numbers and social media. According to, there are more than 36 million results for “how to play pass out game” and more than half a million more for “how to play choking game.” Some of these are news reports, but others are tutorials made by kids. 

Sites like YouTube and Facebook have made attempts to take down troubling clips. In December 2017, YouTube announced in a statement that its guidelines “prohibit content that’s intended to encourage dangerous activities that have an inherent risk of physical harm," and the company said they were taking a more proactive stand against videos that threaten child safety, such as Choking Game clips. But that hasn't curbed the issue entirely, especially given the mere volume of social platforms on which these clips can live. 

"Children are seeing more violence across the board, from social media and video games to television shows," observes Carla Marie Manly, PhD, a clinical psychologist in California and author of Joy from Fear. "Children’s brains are highly impressionable, so they will want to learn and imitate what they see. A child’s brain is not fully formed until age 25, so children simply are more reactive and impulsive."

Warning Signs That a Child May Be Engaging in the Choking Game

The CDC notes that kids who participate in the self-strangulation activity might exhibit the following symptoms or behaviors:

  • Marks or bruises on the neck
  • Bloodshot eyes
  • Wearing clothing that covers the neck, even in warm weather
  • Confusion or disorientation after being alone for a period of time
  • The presence of unusual items such as dog leashes, ropes, scarves, bungee cords, and belts
  • Severe headaches, often frequent
  • Secretive behavior, irritability, hostility
  • Bleeding under the skin of the face and eyelids

Other signs may include:

  • Wear marks on furniture (bed posts, doorknobs, etc.)
  • Linens or ropes tied around doorknobs or furniture or in closets
  • The frequent need for privacy

A’nna Jurich, LCPC, CRADC and Executive Director at The Gateway Foundation in Illinois advises concerned parents to look for "bruising around the neck, bumps or bruises on the head or face—from falls or when they pass out—complaints of headaches, and uncommon drowsiness." 

Parents will also do well to keep an ear out for the wide variety of synonyms for the Choking Game, such as the pass-out game, space monkey, the fainting game, scarf game, space cowboy, California choke, the dream game, cloud nine, and purple hazing. 

How Parents Can Protect Their Children From Self-Strangulation Activities 

Parents who are concerned about their child engaging in self-strangulation activities will do well to keep an eye on their child's media diet, advises Manly. "Be on the lookout of violent video games, internet activity searching choking games/behaviors, texts, or social media geared toward abusive behaviors," she says. 

While children might be tempted to “play” these games at school, Manly says they're "far more likely to occur in less supervised environments such as parties, bedrooms, or secluded outdoor settings. The more children are monitored by actively engaged adults, the less likely dangerous activities will occur."

Considering a child's mental health and behavioral history is key, as well, according to Kirsten Bechtel, MD, a Yale Medicine pediatric emergency medicine doctor and co-director of injury prevention. "The kids who participate in the Choking Game tend to have had some coexisting behavioral health concerns," she says. "They have previous history of impulsive behavior, risky decision making, or suicidal ideation in the past."

If this is the case for a child, Dr. Bechtel recommends parents ask themselves questions like: "What is their access to firearms and medications? And if they tried to do high-risk behaviors like the Choking Game, did they want to die or did they get euphoria from surviving it? This is something we need to screen for safety in kids who have had behavioral health problems in the past."

She also emphasizes that parents shouldn't worry that discussing the Choking Game with a child will increase the likelihood that they will do it. Given the prevalence of the YouTube videos, chances are they're already aware of the details. Dr. Bechtel recommends asking questions like, "What would you do if you knew your friend was doing the Choking Game? You know there’s no going back if it doesn’t go right?”

Parents will also do well to put it in the context of safety, she says. "Ask 'what other things could you die from?'" Dr. Bechtel notes. "Take this chance to address other risky behaviors like not wearing a seatbelt and underage drinking." 

Manly also believes that parents should be prepared to suggest "positive replacement behaviors and games." "For example, playing basketball outdoors, playing 'old' games like Twister, dodgeball, and taking a walk to the park," she says. "Children may enjoy replacement behaviors such as making cookies or creating a home science project."

The bottom-line is that "children want to connect," Manly points out. "Children want attention. When a parent takes the time to model positive behaviors with a child—and quietly supervise children when they are engaged in play, etc.—the child will be far less likely to act out."