Background Child Death Overview Panels (CDOPs) in England are responsible for reviewing how and why children die, and should put in place interventions to try to prevent future deaths.

Method In one region 4 adolescents were found hanging from bunk beds, without obvious risk factors, raising the possibility that adolescents were playing ‘the choking game’ and death was unintentional. 150 other CDOPs were contacted to enquire whether similar hanging scenarios had been reported.

Results 62 adolescents were reported to have died from hanging, 27 from bunk beds.

Discussion The choking game is ‘self-strangulation or strangulation by another person, with hands or a noose, to achieve a brief euphoric state caused by cerebral hypoxia’. It is also known by other names eg. ‘blackout’, ‘five-minutes-in-heaven and ‘space monkey’. Participants are usually adolescents – a North American study found 68% had heard of the game, 45% knew somebody who played it, 6.6% had tried it and 40% perceived no risk, although this is difficult to quantify. Warning signs include marks on neck, headaches, blood-shot eyes, changes in personality.

Social networking sites have enabled millions to watch videos of the choking game, which may normalise the behaviour. Most bunk beds are made using metal tubes or timbers, their design enabling easy attachment of ligatures.

Conclusion Adolescents must be made aware of the dangers of this activity and parents and professionals need to recognise the warning signs. There is the potential for bunk beds to be designed to eliminate anchoring points for ligatures.