Kids and teens can make some pretty hairbrained choices sometimes. But when a kid's choice is to engage in a TikTok challenge that threatens their life, psychiatrists can struggle to understand if it was just an exasperating poor choice born out of impulsivity and immaturity or something darker—an actual suicide attempt.

In a Viewpoint published today in JAMA Psychiatry, two psychiatrists from the University of Tennessee Health Science Center at Memphis raise the alarm about the dangers and complexities of TikTok challenges. They're an "emerging public health concern" for kids, the psychiatrists write, and they're blurring the lines between unintentional injuries and suicide attempts in children and teens.

The child and adolescent psychiatrists Onomeasike Ataga and Valerie Arnold say that their psychiatry team first saw injuries from TikTok challenges during the COVID-19 pandemic, but the trend has continued since the pandemic eased. Over recent years, they've seen children and teens hospitalized from a variety of challenges, including the "blackout challenge," in which participants attempt to choke themselves until they pass out; the "Benadryl challenge," in which participants ingest a large amount of the allergy medicine to get high and hallucinate; and the "fire challenge," in which participants pour a flammable liquid on their body and light it on fire. In these cases, the psychiatry team is sometimes called in to help assess whether the children and teens had an intent to self-harm. It's often hard to determine—and thus hard to decide on treatment recommendations.

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