More than 80 young men and women have died after taking part in a dangerous "game" that involves temporarily cutting the blood flow to the brain.
Teenagers taking part in the so-called "choking game" - which is similar to erotic asphyxiation - use dog leashes, bungee cords wrapped around their necks to reduce the amount of oxygen to the brain.
Their goal is a dreamlike, floating-in-space feeling when blood rushes back.
American officials estimate as many as 20 per cent of teenagers and preteens play the game, sometimes in groups.
The first count of deaths caused by the practice found 82 youths aged between 9 and 16 had been killed while taking part.
But nearly all the deaths were youths who played alone, according to the count complied by the US Centers for Disease Control and Prevention.
Nearly 90 per cent were boys, at an average age of about 13.
Officials have urged parents to be aware of the practice, and to watch for possible warning signs like bloodshot eyes, marks on the neck, frequent and severe headaches, disorientation after spending time alone, and ropes, scarves or belts tied to bedroom furniture or doorknobs or found knotted on the floor.
Many of the children who died form the choking game were described as bright, athletic students who apparently were intrigued by a method of getting high that does not involve drugs or alcohol.
Erotic asphyxiation, which involves blocking oxygen to the brain in order to increase pleasure from orgasm, is typically popular among older men, from 15 to 25.
Michael Hutchence, lead singer for INXS is rumoured to have died from auto-erotic asphyxiation in 1997, although suicide was the official cause of death
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