The rise of ‘elective injuries’

Mackenzie Bean (Twitter) – Tuesday, April 11th, 2023

The rise of platforms such as TikTok and Instagram has created a new enemy for hospital emergency departments: viral social media challenges.

The challenges encourage social media users — usually children or teens — to attempt risky or dangerous behaviors that can require emergency care. 

One of the first internet challenges Becker’s reported on was the “Hot Water Challenge,” which first gained popularity on YouTube in 2017. The trend challenged people to drink boiling water through a straw or pour it on someone who was sleeping. Various challenges have gone viral in the years since, prompting warnings from clinicians, police and federal agencies. 

In 2021, physicians warned against the “Milk Crate Challenge,” a viral phenomenon in which participants attempt to walk up a pyramid of milk crates until they reach the top or fall. Hospitals nationwide saw a range of injuries tied to the challenge, including shoulder dislocations, ACL tears, broken wrists and spinal-cord injuries, according to The Washington Post. At the time, Shawn Anthony, MD, an orthopedic surgeon at New York City-based Mount Sinai Hospital, said these “elective injuries” were consistent with those he often sees from an accidental fall off a ladder or skiing accidents. Many physicians also expressed concern that the social media challenge was placing more stress on hospital EDs already overwhelmed with a flood of COVID-19 patients. 

Other viral challenges have involved the improper use of over-the-counter medicines. In 2020, clinicians warned about a viral challenge that encouraged teens to take excess doses of Benadryl to get high or hallucinate. Some hospitals, including Cook Children’s Health Care System in Fort Worth, Texas, reported an uptick in patients who overdosed on the allergy medication. Another challenge, dubbed the “NyQuil Chicken Cooking Challenge,” even prompted an FDA warning in 2022. 

Most recently, viral challenges have surrounded the ingestion of dangerous amounts of alcohol or incredibly spicy food or gum

The viral challenges outline one of the dark sides of social media and its sometimes devastating consequences. The “Hot Water Challenge” was linked to the death of an eight-year-old girl in 2018 who required a tracheotomy after ingesting boiling water through a straw. That same year, another internet phenomenon dubbed the “Fire Challenge” left several kids in the hospital with critical burns after pouring rubbing alcohol on themselves and lighting it on fire.