Yesterday, the Centers for Disease Control released the first ever U.S. government count of fatalities caused by something called the choking game. Seriously, that's the name. And the kids, quote, "play it" by using all kinds of methods to temporarily cut blood flow to their brains in order to get that dreamlike tingly feeling that comes when the blood rushes back into the brain.

According to the CDC study of at least 82 children, they died this way between '95 and 2007. And the CDC says that it may be a conservative estimate, because so many kids seem to engage in the practice. It's usually done in groups, but fatalities most often occur when it's done alone.

The CDC was motivated to look in to the choking game after receiving a letter from Dr. Patricia Russell, a physician in Tacoma, Washington, who said her 13-year-old son Colin died from playing the game in 2005. She co-authored the CDC study. We talked with her yesterday about that study and the day her son died.

Dr. PATRICIA RUSSELL (Family Practice, Tacoma, Washington): My son and his younger sister were here with our part-time nanny, a college student who had been with us for four years. My husband was out of town visiting his parents, and I was at a meeting at the hospital. And he had just learned how to do a trick he'd been trying to do all summer on his skateboard called a kick flip, and was really excited. Did his homework, had dinner. He and his sister went to their rooms to clean them and then he was going to meet a friend again later after dinner. So that was the setting.

Jen, who, you know, kind of like family, was still down work downstairs. And so later, I think, maybe half an hour or 40 minutes later when she called for him, he didn't answer. And so she and Molly went into his room and he was in his closet hanging from a closet rug, which he was a quite a bit taller than, actually.

They called 911, and the paramedics came. I was called. I got here after they had attempted to resuscitate him for half an hour and were unsuccessful.

STEWART: I have to ask you, why didn't you think that this was suicide?

Dr. RUSSELL: My first thought was, how can you hang yourself on something that was shorter than you were? And my second thought is why would he do that? He's, you know, he was an extremely happy kid. We had talked the night before about him having his very first Halloween party in the attic that we were remodeling into a family space. And so you can imagine in that context, when I heard about something that might be a reason that a child might be found strangled, then I started investigating it.

STEWART: So a family friend, one of Colin's friend's mothers planted this seed in your mind. It said - told you that she knew that Colin had been discussing this choking game. Did you have any idea what that was?

Dr. RUSSELL: No, not till that night. I mean, somebody - people were coming to sit with me while the detectives were upstairs, and our sons were all very good friends. And this was one of his really best friends, and yet, apparently, Colin had not told any of his closest friends that he was experimenting with this.

There's a lot that I still don't know.

STEWART: You have helped conduct the first federal national comprehensive study on this phenomenon. So what has this study borne out? Is this a widespread problem or these isolated and very tragic incidences?

Dr. RUSSELL: The study has borne out that this is real, and these are not suicides. It makes it, actually, look like it's less of a problem than it is because of what they did. The first thing that they did was try to go to databases that get, you know, information from death certificates, and they realized that that was not going to be somewhere where they could really get information at this point.


Dr. RUSSELL: Well, for one thing, everything is converted to numerical code called an ICD code, and there isn't one for this. So even if you go back and you say, okay, well, how many accidental strangulation deaths were there? You don't know if that was, you know, an Isadora Duncan scarf in the machine kind of thing or somebody who is playing this game. And when they couldn't use the data of existing databases, then they went back and they did the media review, and then that's what they were reporting. And they had very compelling information that shows that the demographics for the kids who are playing this is very different from, you know, age wise, from the one that are committing suicide.

And I have a database that's quite a bit larger than them because I have lists that include parents who've just come to advocacy groups and said this is how my child died.

And so, they or their coroners have not gone to the media, and so the CDC, looking for some way to get a handle on this, did media only.

STEWART: How can you verify that those 82 children really did die from doing this to themselves in this unintentional way, without trying to kill themselves?

Dr. RUSSELL: There's a couples of questions in it. Number one, is a specific and one is somewhat general. The specific question is that they were very narrow. So I have many more articles where there was a dispute between a medical examiner and the family about what the intention was, okay. So those were all taken out. Those are not included in the 82. So it's only ones that were reported in the media to be due to choking game.

Most of those have corroborating information. One thing that even as a physician that I never knew until this happened, I did not realize that a medical examiner or a coroner in any jurisdiction anywhere has the sole and final say in making this determination, and they don't even have to wait for the police investigation to be completed. And if there is a disagreement, there's no process for that to be changed except for somebody to take it to court.

So there's a real - that's an underlying problem. There probably are a significant number of suicide determinations that are not the best determinations out there right now - not enough to make suicide not a huge problem, which it is, but enough to make the numbers for this lower than they really are.

STEWART: What do you hope that this report achieves? Is this about just raising public awareness, or is this something else that you want to see changed?

Dr. RUSSELL: Raise awareness of the choking game, get kids to stop doing it because it's extremely dangerous. And then, ideally, start a discussion about some sort of improved process that would bridge this problem we have between the forensic community and the public health community.

STEWART: This is clearly a frightening phenomenon, especially for parents. What message do you have for them? What should people be looking out for?

Dr. RUSSELL: Warning signs can be very subtle, unless a child is addicted. And there have been several parents who, it turns out, realized their child is actually probably addicted to this activity, and that's one of the potential problems with it. But warning signs are unusual interesting ligatures, coarse voice, or hiding marks on the neck, hearing some of the names like Space Monkey and, unfortunately, there are literally dozens of them. It's very regional that kids might call it this, but Space Monkey is a big one. Choke Out, Pass Out are two other fairly big ones. If kids are playing a lot and are addicted, they may have some behavior changes.

I think the hard thing for me is even though I'm a physician and I was very up on a lot of things, I was relying heavily on my school district as a parent and my public health system as a physician to keep me informed, you know, on new things like this. And now I realize that some things are going to be missed, like this was. So, as a parent, I now actually get online a lot more and just look at risk taking in general just so that I can watch out for my other job.

MARTIN: Dr. Patricia Russell, a family practitioner in Tacoma, Washington. Thank you very much.

Dr. RUSSELL: Thank you, Rachel.

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