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The growing prevalence of the choking game in New Zealand schools has prompted the Ministry of Education to circulate a warning to parents and caregivers to be vigilant about the safety of their children during the summer holidays.
The schoolyard game involves young people choking themselves or others to get a sudden rush, and some schools had circulated their own warnings after a 12-year-old Tauranga boy was thought to have died playing the game last year.
However, the Ministry of Education has now circulated an official warning to parents and caregivers through schools about the dangers as the number of young people ending up in emergency departments after accidentally harming themselves was growing.
In an email sent to all primary, intermediate and secondary schools this week, Ministry of Education deputy secretary Rawiri Brell said the summer holiday was a time when parents needed to be vigilant about the safety of their children.
"This game is dangerous and can end in death. The danger is increased if the child is alone when they try it," he said.
"This game can start as an innocent risk-taking experience, but if the brain is starved of oxygen, serious consequences - including death - can occur."
Mr Brell said signs of people playing the game included marks or bruises on the neck, bloodshot eyes, bleeding under the skin of the face and eyelids, and the presence of unusual items, such as dog leashes, ropes, scarves, bungee cords and belts.
If parents or caregivers noticed any of the signs, there were steps they could take to ensure their child's safety.
"You can start by asking them if they have had any worrying texts, emails or Facebook posts."
He said if they had, then ask your child about them and tell your child to delete them instead of passing them on.
"Ask them if they have heard about the choking game ... tell them that this is very dangerous and they could die.
"Tell them that the 'floaty feeling' or 'pass out sensation' is the beginning of brain damage - brain cells are dying and that can cause death or permanent brain damage."
Mr Brell said young people's behaviour could change from day to day, and he encouraged parents to talk to their children often.
"If you are concerned about your child, discuss your concerns with them and remain vigilant," he said.
"Check cellphone texts, keep bedroom doors open, check if groups of children are in a shed together. Safety is more important than privacy."
Otago Secondary Principals' Association president Julie Anderson said there had been no signs of the game being played on Otago schoolgrounds to date, but the email would be forwarded to parents and caregivers because it contained helpful advice about how to keep children safe during the summer holidays.
"It has been a problem in some North Island schools, but we haven't seen any signs of it here, thank goodness."
Signs teens are playing the choking game:
• 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 behaviour, irritability, hostility.
• Bleeding under the skin of the face and eyelids.