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Within the last two weeks, two adolescents who played the "choking game" have been treated at Monroe Carell Jr. Children's Hospital at Vanderbilt, and hospital officials say it's likely others are also engaged in the activity.

The game involves choking someone to the point of passing out. Warning signs include bloodshot eyes, marks around the neck, wearing clothing that covers the neck and items that can be used for choking left around or near bed posts.

"This is not a game, even though we call it a choking game," said Purnima Unni, the hospital's pediatric trauma injury prevention program coordinator. "There are no winners here. There are only losers."

The game results in lost of consciousness or more serious consequences, such as brain damage or even death. The game can be carried out on playgrounds among younger children or at teenage sleepovers. It activity is prevalent enough that the U.S. Centers for Disease Control and Prevention has also issued warnings.

"Our fear is that there may be a lot of kids out there doing this," Unni said.

One of the patients treated at the hospital was a pre-teen. The other was a teenager. The cases were separate and unrelated. Unni noted that adolescents who engage in this activity do not typically take drugs. They are often athletes or high-achieving academic students.

"The more you find about it, it is very addictive in nature," Unni said. "Kids think it is a quick rush or a good way to get high."

The game can progress to the point that someone plays it alone, which greatly increases the likelihood of death.

The activity is sometimes called the "fainting game," "pass-out game," "knock-out," "dream game" or "space monkey." It has been around for decades, but is something that parents are reluctant to talk about, Unni said.

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