Tua Muai was mischievous, but never malicious. Never mean.

He was 12, and loved to play football, but even in the sometimes brutal sport, Tua exuded sportsmanship, said his mom, Celestia Muai.

“He would lay a hit on somebody, where you could hear the kid go, ‘Uhh,’ but then he would stop and help the kid up and pat him on the shoulder pad and just give him as smile,” Muai said.

Muai wants other families to know about her son, Tua, who went outside to play in his backyard May 11 and died there. Police believe Tua suffocated while playing the “choking game.”

(Courtesy of Celestia Ballard Muai) Tua Muai, 12, poses for a picture with his mom, Celestia Ballard Muai. Tua, who loved football, died May 11, 2018, while playing the "fainting game."

Although the phenomenon goes by many names, including the fainting game and the pass out game, it involves people restricting their breathing until they pass out.

When a person comes to, they are often dizzy and light-headed, which can feel similar to euphoria, said Matt Parsons, an emergency medical doctor with Intermountain Healthcare. He said that’s the rush children are seeking.

According to Erik’s Cause, a group dedicated to raising awareness of the phenomenon, children participate for a number of reasons:

  • It’s not illegal, yet it produces a kind of high.
  • It doesn’t require any products or special equipment.
  • It can be done alone.

Those moments of euphoria — caused by a lack of oxygen and glucose going to the brain — can lead to permanent brain damage or, like in the case of Tua, death.

“The difference between passing out and coming to in a few moments and having euphoria and having permanent brain damage or death is seconds to minutes,” Parsons said.

The doctor said there’s no “safe” amount time to deprive the brain of oxygen, and doing so may be more dangerous for children, whose brains are still developing.

Parsons, along with the group Erik’s Cause, encourage parents to talk to their kids about the dangers of self-choking, which Muai said she did after she heard her children and their friends talking about it.

But, just as Muai believes children’s brains are not developed enough to understand the consequences of cutting off its blood supply, she doesn’t think children will take their parents' warnings seriously unless they see that this is really happening.

“I hope that people see the pictures of my son, and my family, and know that this is real,” she said.

It’s unclear the extent to which children are self-choking because there’s not enough data to make many conclusions.

The Centers for Disease Control and Prevention added an optional question related to the choking game for the state-by-state Youth Risk Behavior Survey in 2011. Since then, only Utah, Florida, Kentucky and Montana have asked it, CDC spokesman Elizabeth Davenport said.

Utah included the question in 2015 and 2017, though the results for the initial test weren’t usable because of low participation rates, said Michael Friedrichs, Utah’s Youth Risk Behavior Survey coordinator.

According to the 2017 data, 10.3 percent of students in ninth through 12th grade said they’d tried the game. The results showed little difference in the rates among boys and girls, though there was a slight decline in participation as the students got older.

Muai, from South Jordan, said she thinks more children are self-choking than people realize. For instance, she remembers kids doing this in her Montana middle school.

In Iron County, a series of child deaths that occurred between 2009 and 2013, prompted the school district to education their students about the choking game.

In 2014, the district was among the first in the nation to take up a curriculum from Erik’s Cause to teach students the dangers, said Rich Nielsen, Iron County School District’s director of secondary education.

Nielsen said about 1,000 students in grades 7 and 11 go through the program every year as part of their health curriculum.

“My take on it is you have to provide accurate information. The kids, inevitably with our social media world, they are going find out information. We’d rather it be accurate information in a controlled environment, rather than online at night with nobody around,” he said.

Nielsen said it’s hard to judge if the program’s working, but he has “a strong suspicion that something is better than nothing.”

Since 2014, no deaths in the county have been attributed to the game, according to Erik’s Cause data.

Across Utah, only two children’s deaths have been traced back to the game since 2014: Tua’s and another child in West Valley City, who died in February 2018, according to the data.

Muai believes the choking game may be making a comeback through how-to videos accessed through social media.

On the other hand, she said, that kind of exposure means when a child dies, more people hear about it. Since Tua’s death, Muai said, parents have reached out from across the country to tell her they’ve been through something similar.

Muai said she hopes others will see what happened to her son — an exuberant boy with big plans of going to Brigham Young University, then the NFL, and one day becoming a scientist — and be upfront with their children about how he died.

“He didn’t break any laws. He was just playing a game and he didn’t think things through,” Muai said. “He just didn’t think things through all the way.”