A deadly "choking game" that started in America is now being played in Hawke's Bay playgrounds and homes, prompting a strong warning for local schools.
In the "game", young people hyperventilate to create a mild rush when oxygen is returned to the brain.
Sometimes another child squeezes their chest tightly until the other child faints.
It has been the cause of hundreds of deaths overseas.
Hawke's Bay Public Health Unit paediatrician and clinical director of maternal, child and youth service, Russell Wills, is so worried he sent an advisory to local schools, asking principals to warn students of the dangers.
"It is better that principals are aware of it and can deal with it firmly and immediately and also so they understand the risks," he said.
British doctors have warned the choking game can lead to seizures, head injuries, strokes, heart failure and brain damage.
It was not known how long it had been happening in Hawke's Bay, but Mr Wills said it terrified him.
"Discussions with young people suggest that the game is prevalent in secondary schools in Hawke's Bay, mostly among Year 9 to 11 students and boys," he said.
"It is impossible to know the prevalence of the game but it appears to spread through schools like a virus, like many other practices, and then not happen for a while," he said.
HB Secondary Schools Principals Association president Neal Swindells said he had not heard of any schools in Hawke's Bay being affected, "but that doesn't mean it's not happening".
Hastings Girls' High School sent out a warning in its school newsletter, describing warning signs that a student may have tried it.
Those included bloodshot eyes, marks on the neck, frequent severe headaches and disorientation after spending time alone.
Ropes, scarves and belts tied to bedroom furniture or doorknobs or found knotted could also be a sign a student may have tried it.
Campaign group Games Adolescents Shouldn't Play said up to 458 children in the US and 86 in Britain had been killed this way.
Footage of British students trying the game had been posted on YouTube, helping the practice to spread worldwide.
It is known by several names including "space monkey" and "funky chicken".
In New Zealand, Child Youth Mortality Rate Committee statistics for 2006, showed 60 young people aged 5 to 19 died through suffocation, an increase of 15 on statistics from 10 years earlier. Such a practice may appear among them as "inexplicable suicide".
Warning as deadly choking game hits schools
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