Parents, listen up. The people at the Centers for Disease Control and Prevention (CDC) have something important they want you to know about. It’s called the “choking game,” although it’s also known as the “blackout game,” “pass-out game,” “scarf game,” and “space monkey.” Although the game seems to have been around for a while, the CDC has made its first effort at tallying deaths caused by it. And the result is chilling.

According to their limited data, 82 youngster deaths can be attributed to the game between 1995 and 2007. The youngest victim was just six years old. Keep in mind that because there is no mandatory reporting for choking game deaths, the CDC’s researchers relied primarily on data culled from news reports. It may be that the CDC’s figure is a serious underestimate of game-related deaths. Furthermore, the CDC has not calculated game-playing incidence or injuries, only deaths.

It seems wrong to be referring to an act that can result in death as a “game.” Choking should never, ever be treated as a game! But some children are, in fact, “playing” at it. The CDC explains that the game is “self-strangulation or strangulation by another person with the hands or a noose to achieve a brief euphoric state caused by cerebral hypoxia” (deprivation of oxygen to the brain). This is different from autoerotic asphyxiation or suicide by choking.

Perhaps most worrisome of all is this line from the CDC’s report: “In this study, few of the parents of children who died had been familiar with the choking game.” A whopping 92.9% of parents said they were not aware of the game until their child died.

Here’s what the CDC wants us parents to do—learn about the game and be able to recognize the following warning signs:

• Mention of the choking game (by that name or another)
• Bloodshot eyes
• Marks on the neck
• Frequent, severe headaches
• Disorientation after spending time alone
• Ropes, scarves, and belts tied to bedroom furniture or doorknobs or found knotted on the floor

In the only survey to attempt to quantify choking game play among youth, the 2006 Williams County, Ohio, Youth Health Risk Behavioral Survey found that 11% of youths ages 12-16 and 19% of those ages 17-18 reported ever playing the game. That’s nearly 1 in every 5 teens. With the identified deaths occurring in 31 states, we can only surmise that this game is relatively widespread.

The bottom line is this—as with so many risks (e.g., drugs, alcohol, teen pregnancy), the best prevention is to pay attention to what your child is doing. Keep an eye out for warning signs, and know your child.