Investigators in David City, Neb., held a public forum Tuesday night to raise awareness about the "choking game," a dangerous activity that authorities believe caused the recent death of 11-year-old Drew Fiala.
"We want to raise awareness. We've never encountered anything like this before," Butler County Sheriff Mark Hecker told AOL News. "We're still in shock, both my department and our community."
Fiala was found dead in his bedroom March 12. A belt was found wrapped around his neck, and the medical examiner determined the boy died of suffocation.
"There were no signs of foul play or anything leading to him intentionally hurting himself," Hecker said. "Based on the evidence at the scene and interviews we conducted with other kids in the community, we were able to tie everything together, and that's what led us to believe that Drew was involved in the choking game."
According to Kate Leonardi, director of the DB Foundation, the choking game goes by a variety of names, including "passout" and the "fainting game." Both males and females participate, although they typically use different methods. Girls, Leonardi said, usually do it at parties, using chest compressions, whereas boys generally use their hands to choke one another.
"The purpose is when you have restricted oxygen and blood flow to your brain, you get a euphoric rush," Leonardi told AOL News. "Kids have described it as a fuzzy feeling, where your vision goes black and you get very woozy. That is the sensation that they are looking for, and once that happens the pressure is released, whether it is a friend holding them or the ligature, the blood that was then dammed up is rushing into your brain, giving you a secondary sensation."
Leonardi has personal experience in the choking game. She founded the nonprofit DB Foundation to raise awareness about dangerous adolescent behaviors after her son fell victim to the choking game.
"I found out about it when my 11-year-old son Dylan died," Leonardi said. "He did it by himself from off of a bunk bed using a belt."
Leonardi said young boys who go solo and attempt to attain the rush using a ligature have an increased fatality rate of 91 percent compared to girls.
"These kids don't realize that once they've decided to use a ligature to reach the sensation, they're not aware of the mere seconds that it takes from acquiring the sensation to becoming unconscious, so their own body weight kills them," Leonardi said.
Studies regarding how many children a year die from the choking game show mixed results; however, Leonardi said she has seen some statistics citing upwards of 1,000 cases a year.
"It is really difficult to pin down, because a lot of these cases are classified as suicides," she said.
Death, however, is not the only danger of the choking game. Participants can also suffer serious lifelong consequences. "They can suffer permanent brain damage, memory loss and other medical problems," Leonardi said.
So what can parents do to prevent their children from falling victim to the game?
"Include it in that talk with your kids about risky behavior -- put it on the list of sex, drugs, drinking," Leonardi said. "All of it is a conversation you need to have. Bring it up and make sure it is on their radar."
Sheriff Hecker agrees and also points to possible warning signs.
"Look for unusual bruising in the neck area," he said. "Ask your kid, 'Where did that come from, how did it happen?' You should also be observant of redness in the eyes from ruptured blood vessels and routine complaints about severe headaches."
More suggestions about how to speak to young children about the dangers of the choking game can be found at the DB Foundation's Web site at chokinggame.net.