Games Children Play: The Choking Game, The Pass Out Game

03 Mar

Remember all the young and stupid things you did when you were young and stupid? Jumping off the garage with a pillowcase parachute? Swinging off a tree limb into the creek or pond without first testing the depth of the water? Building a ramp to jump over on your bicycle? Taking a ride while clinging to a car front fender? We all did these things yet somehow survived. Unfortunately young Brandon Stine didn’t.

There seems to be a game going around among children Brandon’s age, which was 11 at the time of his death. It goes by many names: the Choking Game, the Fainting Game, the Pass Out Game, Tap Out, Hangman, Elevator, and a few others. The goal is to lose consciousness. I remember in grammar school a similar game came around. The person would take 20 deep breaths and blow on their thumb and immediately become dizzy and lose consciousness. I never played this game but I saw it on several occasions. Somehow losing consciousness wasn’t very appealing to me. And of course now that I know the physiology behind it, it is not only unappealing it is frightening.

The current games are played two ways. The first is easy to understand and the second requires a little more complex physiology.

One form is simply to choke the victim until he loses consciousness. This is basically the choke hold police sometimes employ to control combative suspects. The purpose is to block blood flow to the brain by compressing the carotid arteries. This results in low oxygen levels in the brain, which in turn leads to loss of consciousness. It can also lead to death.

The second form results from self-induced hypocapnia. Hypocapnia is simply a big word for low carbon dioxide (CO2) levels in the blood.

The human body guards a handful of things very jealously. Some of these are the oxygen, CO2, and pH of the blood. The pH is a measure of the balance between acid and base (alkalinity) in the blood.

When oxygen levels are low, the brain sends out signals that increase the rate and depth of breathing as well as the heart rate and blood pressure. This brings more oxygen into the lungs and increases its transportation by way of the cardiovascular system to the body. When the level of oxygen in the blood is very high the exact opposite happens in that breathing will slow since there is no physiologic need to move more air.

Carbon dioxide works the same way, only in reverse. If the carbon dioxide levels are high, breathing will increase to “blow off” this extra CO2, which is an acid. Since CO2 is removed from the body through the lungs any increase in breathing rate and depth will remove more CO2 from the body and the acid-base balance (the pH) will be restored. If the CO2 is very low, this drive to breathe is suppressed so that more CO2 will accumulate within the blood and again restore the pH balance.

High CO2 levels elevate the amount of acid in the blood and this is reflected in a falling pH level. The lower the pH the more acidic the body is. A low pH adds to the drive to breathe more rapidly so that the CO2 level will drop and the excess acid is removed in this way. When the CO2 level drops, the pH rises and the drive to breathe is suppressed.

This is a thumbnail and does not take into consideration the many other derangements within the body that can alter the pH level.

In summary, a low oxygen level, a high CO2 level, and a low pH (excess acid in the system) tend to increase breathing so that more oxygen is supplied and more CO2 is removed from the body. When the oxygen level is high, the CO2 level is low, and the pH is elevated (excess alkalinity in the system) the driving force to breathe is suppressed.

When someone purposely hyperventilates by breathing rapidly and deeply for a minute or so they are increasing their oxygen and pH levels while lowering their CO2 levels. This in turn suppresses the need to breathe. This can lead to a period of slow or absent respiration, which tends to continue slightly longer than is needed. This overshoot is part of virtually all biological feedback systems. This can result in a rapid drop in blood oxygen levels to the point that the victim loses consciousness.

This drop in blood oxygen level is more dramatic and more rapid than is the restoration of normal CO2 levels that would accompany a cessation of breathing. This means that by the time the CO2 levels reach a point where they again drive respirations, the oxygen level has fallen very far. This is what leads to loss of consciousness and death. Or perhaps survival with permanent brain damage.

An identical situation arises when someone attempts an underwater swim across a pool. Or a free diver attempts to go to very great depths on a single breath. In each of these situations the person hyperventilates before taking the plunge and in so doing creates a situation where they could lose consciousness and drown during the swim or the descent.

If you, or anyone you know, has children who are playing this game, it’s time to sit down and have a chat. This is basically Russian Roulette where the bullets are the oxygen and carbon dioxide levels in the blood.


13 responses to “Games Children Play: The Choking Game, The Pass Out Game

  1. Jo Vandewall

    March 3, 2011 at 3:17 pm

    This is very interesting, and I’m wondering if there’s some reason one couldn’t elevate someone’s oxygen levels by having them breath the higher oxygen concentration from an oxygen tank (the kind someone with COPD would have.) Would there be a way to commit a nearly untraceable murder? (Asking rhetorically for fiction of course.)


    • D.P. Lyle, MD

      March 3, 2011 at 7:10 pm

      This scenario is dangerous and potentially deadly for someone with severe COPD but not for someone who is healthy. A healthy person wouldn’t have problems from an elevation in inspired oxygen. The physiology underlying why it is dangerous for those with severe COPD is too complex to go into here. So your scenario could work in someone with severe COPD but not in a healthy individual.


  2. Pat Marinelli

    March 4, 2011 at 8:03 am

    Dangerous and deadly, yes. I’ve read about this in the newspaper. Every once in a while we have a cuple of deaths in our area. They seem to go in spurts.

    Thanks for all the details that would help a writer who wants to use this in thier work.


  3. Jody

    March 8, 2011 at 11:03 am

    What’s truly sad is that this game has been being played for many years. My grown daughter, when I warned her to talk to her son when it was going around in our town about 5 or 6 years ago, told me it had been going on when she was in middle school! How many children have to die? We had a child in our neighborhood die a few years ago that the police couldn’t decide if it was suicide or from playing the game. His parents are sure it was the game.


  4. Bonnie

    November 3, 2011 at 1:48 pm

    1st and formost, we need to rename this horrible ‘thing’, from ‘choking game’ to CHOKING DEATH. My son died of it in 1989 after 7 years of counseling. He learned how to do it in a tent with other kids at a boy scout camp out. He was 11 when it started and 18 when he finally died from this. I can’t tell you how many of those 7 years I watched him like a hawk so he would not kill himself. He said it was all in fun and he wouldn’t hurt himself. How dumb…..what a waste of a life. He had so much to live for. This is not mentioned very often but this ‘game’ also gives kids a sexual high better than anything they could ever experience in the normal way and has been around since time began.


  5. Mary Lou

    December 6, 2011 at 5:24 pm

    This just happened to a friend of the family
    he was just 15 how can we get this really out


  6. Jacqueline

    February 2, 2012 at 2:41 pm

    my son is 8.I received a phone call from the principal that my son and another child were choking themselves in school today. The fear and worry that struck me today has been overwhelming.I explained to him the dangers of this, but how do you deal with this? I cant watch him every moment of every day.


    • Janet Watson

      March 27, 2013 at 8:27 pm

      Just watch for the signs Jacqueline. Blood shot eyes, red marks around the neck, devices that could help them hang items to…eg: hooks on ceilings, pantyhose, to use around the neck…look it up, there are a lot of things to help parents to know the signs. We lose a child in my family to this sick game….and his room was in the basement, and he rigged something to the rafters in the basement. Pls, pls watch for signs.


  7. Janet Watson

    March 27, 2013 at 8:23 pm

    We just buried another child in our, not counting my nephew who passed away from this stupid so called game. When I watched the videos of kids doing the fainting game, and the one doing the heavy breathing passes out and starts shaking, the other kids are in the back round laughing. Bet the laughter would come to an abrupt end if their friend died in front of them. This has to end, and I believe from what my family is going thru…it needs to start in schools…not TV interviews..but schools. Guess what tho…the board of education won’t let it in. They will speak about, sex, drugs, but not this deadly so called game. We are going to lose more and more kids to this and the awareness needs to be in school.


    • Janet Watson

      March 27, 2013 at 8:29 pm

      Sorry, let me correct the first line. We just buried the second child in our area.


  8. Rie H

    August 30, 2013 at 2:03 pm

    My son died doing this. He was alone, blacked out and fell and hanged himself.


  9. Rockford Shipley

    October 23, 2013 at 3:57 pm

    I’m a kid this may have saved me from this game of death thanks 🙂 S.H.T.A.L So Happy Thanks A Lot.



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