Eraser challenge

A kin to the salt and ice challenge, the eraser challenge has also been around for many years, and new videos are always available. This can be part of an individual or group competition in which kids and teens recite a song or poem repeatedly while rubbing erasers hard and fast on their skin. The game continues until the last child tolerating the friction is declared the winner.16 An initial rush of adrenaline can block the initial pain of this challenge, but the intense pain can outlast the contest, as the abrasive effects of the eraser can cause a burn-type effect. Scabbing and scarring are the consequences of this challenge, as well as skin infections and bloodborne infections if teens are sharing erasers.

Kylie Jenner challenge

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In this “do it yourself” challenge, teens place a shot glass over their lips and suck forcefully in, causing a suction around their lips, in the attempt to cause “lip plumping” to look more like the teen idol Kylie Jenner. Significant pain, swelling, and bruising can occur from these suction techniques, and there is a risk for scarring and permanent disfigurement with repeated attempts.17 

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Banana Sprite challenge 

In this challenge a person eats 2 bananas and quickly drinks a can of Sprite soda. Allegedly, this causes a chemical reaction in the stomach causing violent and projectile vomiting. Others suggest that the stomach cannot hold that much food, and others state a psychosomatic response to the challenge.18 Risks can include dehydration and electrolyte imbalances due to the excessive vomiting if it continues for a prolonged period of time. 

The chubby bunny challenge or cracker challenge

This challenge involves how many marshmallows or Saltine crackers someone can stuff in his or her mouth at once without any liquid.19 This is a choking hazard, and an airway can become blocked, with risks of aspiration up to and including death. In 2017, a college student died from asphyxiation after ingesting too many pancakes at a fund-raising competition and began to choke.20 The first responders had difficulty clearing her airway, and she succumbed to hypoxia.

The fire spray challenge and the fire challenge 

Both of these challenges are especially risky. In the Fire Spray challenge, the teen exhales some form of combustible liquid (frequently alcohol) and lights it on fire, creating a dragon-like fire-breathing burst, which is captured on video. The fire challenge is a more intense form of the challenge, with a combustible liquid being placed on the skin and people lighting themselves on fire. Both can cause serious burns, scarring, disfigurement, and death.19 

Implications for patient care

Parents may not be aware of their teen’s attempts with any of these challenges. An acute care visit to an office or urgent care site may be scheduled for lip swelling, projectile vomiting, skin infection, burn, or respiratory symptoms, and unbeknown to the parent or provider, a “challenge” may be presenting. Any patient who may have attempted a “challenge” must be handled with the care and confidence as with any of the sensitive adolescent issues such as discussions about sexuality and drug or alcohol use. Speaking privately with the teen before discussion in front of the parents may be a helpful option to discuss the truth in what has occurred as part of a “challenge.” Taking a supportive team approach with the teen and parent can lead to open communication and appropriate treatment. Identification of the risk behavior should also be further explored to determine if this was a copycat prank or an attempt at self-harm or suicide. There are limited correlations between these online “challenges” and documentation of nonsuicidal self-injury in adolescents, but we must be aware of the risk that this can pose in our mental health assessments. There are no data on whether the Internet has increased the incidence of self-harm, but it has “normalized” the behaviors. Teens who are doing these challenges must be thoroughly screened for other self-harm behaviors, with the identification of depression, anxiety, stress, and bullying within the personal or online social arena. Any adolescent who has an identified plan for self-harm should be immediately referred to a mental health professional.

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Additional considerations include collaboration between primary care providers, school nurses, and guidance counselors to acknowledge current trends in their geographic location to best determine these high-risk presentations within the school environment. Community awareness, as well as parents, children, and teens, can help in decreasing the inherent risk behaviors. Providers must remain astute to current trends and be nonbiased in discussing their concerns with the adolescent and parent to provide adequate treatment and support through these “challenging” adolescent years. 

Margaret Quinn, DNP, CPNP, CNE, is a clinical associate professor and specialty director of the Pediatric Nurse Practitioner Program, Rutgers University, in Newark, NJ.


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