Sara closes the door to her room as softly as she can. Her mom is making dinner, occupied with making sure the chicken doesn't burn, and now is her chance. Her heart races and her hands shake. She walks to her closet, opens the door, reaches past the bedazzled T-shirts, pastel cardigans and skinny jeans, and pulls out a baby pink silver-studded belt, the one she had begged her mom to buy her especially to wear with her first-day-of- seventh-grade outfit.

Her mom hates it when she sits on top of the eyelet bedspread, so she's careful to pull it down, removing the stuffed bear and bunny and the gazillion pillows, before plopping down on the sheets. Justin Bieber grins at her from the ceiling. Her brother said that was a stupid place to put a poster, but Sara likes to see him first thing in the morning and last thing at night. Her brother said she was a stupid little girl. Sarah pointed out that he was going to summer school and she had made all A's, again.

The night they had that argument was the night she decided to try it. And it worked! Ashley and her moronic boyfriend were actually right. It felt like nothing Sara had ever experienced, a numbing, buzzy rush, like being half-dead but more alive all at the same time. Transcending life, going out-of-body but also feeling the rush of possibility, the flood of all those feelings that must have been there all the time but were somehow buried beneath the mundane daily grind of school, homework, chores and family dinners. It must be the same for the stoners at school, she thinks. But Sara knows her parents would lock her away for life if she touches drugs or alcohol. They'd threatened as much. This was a way to avoid detection, to avoid punishment, a safe little secret that provided her with something she didn't even know she wanted, didn't even know she was missing, until she discovered it.

This time would be even better. That was the reason for the belt. More pressure, more intense. Afterward, she'd lie there on her bed and breathe deeply and then head to downstairs to dinner. Maybe they'd have ice cream for dessert?

Pink belt tied to the bedpost, the noose secured tightly around her neck, she drops to her knees. Light-headed, euphoric rush, Bieber spinning, Bieber fading, no wait, this time it's different, what's wrong....darkness. Mom thinks she's sleeping, she'd said she didn't feel well, so mom lets her skip dinner. It's hours before they know her body is only a body.

Does This Really Happen?

We don't want to think about children doing this. Not my child, not any child I know, we say. But it's often the ones we least expect who do it. And there's sometimes no warning, until they're dead.

It's not suicide. It's called the Choking Game, and kids do it to get high. The honor students, the well-behaved ones that the teachers brag about, the ones with doting and responsible parents. They may feel that experimenting with drugs or alcohol is too risky and fear getting caught. So they use asphyxiation instead, not fully understanding the danger. Sometimes, this behavior is used to heighten sexual arousal, but that's not what the Choking Game is typically about.

There is increasing evidence that more children are engaging in this so-called game, with those ages 9 to 16 being most susceptible to experimentation. It's especially popular among middle school aged children. They do it by themselves or in groups. The Choking Game has been around for decades, but the increasing instances of children playing it alone or using ligatures means it is becoming more deadly.

What Exactly Is the Choking Game?

The idea is to apply pressure to restrict oxygen and blood flow to the brain, which creates a "high." This can be done several ways, including chest compression, and choke hold neck compression, typically done with a group, or palms to neck compression, hyperventilation, ligatures and thumb blowing.

Once pressure is released, there is another high resulting from the oxygen and blood rushing back into the brain. Whether alone or with a group, the practice of depriving the brain of oxygen can be fatal. With every passing second, brain cells are destroyed. It can take only seconds to go unconscious and only a few minutes for serious injury or death to occur. Within three minutes functions like memory, balance and the central nervous system can fail.

The Choking Game can result in concussions, broken bones from falls, seizures, brain damage, memory loss, retinal hemmoraging, stroke and death.

How Common Is It?

Incidents of the Choking Game have been reported in at least 46 states, but good statistics are hard to find.

One study concluded that there were at least 82 deaths between 1995 and 2007, but it was based only on media reports and could not be verified. It's likely that many of these deaths are reported as suicides, making it more difficult to learn just how prevalent they are. Gaspinfo.com, a Choking Game awareness and prevention site, estimates there are between 250 and 1,000 deaths related to the Choking Game per year in the United States.

The majority of reported deaths - 74 percent - have occurred while an adult was on the premises, according to chokinggame.net, and more than half of those adults in hindsight said they failed to recognize one or more of the warning signs. The majority - 86 percent - of adults said they didn't know about the choking game prior to their child's death.

There have been reports of children who were left alone for as little as 15 minutes dying from the Choking Game.