Why are they so dangerous?

If you have teens or have been following the news lately, you might have heard of the Benadryl challenge. This involves taking more than the prescribed amount of the antihistamine medication, resulting in serious complications, including death. This is one of many “challenges” that have been circulating on the internet in recent years. Why do they go viral? If you have teens, how do you talk to them about this and other dangerous fads?

Benadryl ChallengeThe “Benadryl Challenge” started on TikTok and made the news in May 2020 when three teenagers were hospitalized in Fort Worth, Texas, after overdosing on Benadryl. It made headlines again in August after a 15-year-old girl from Oklahoma City died after trying it. All of these kids weren’t trying to harm themselves. Instead, they were taking the medication trying to get high and experience hallucinations. The video told them to take dozens of pills and to see how it made them feel. If they don’t immediately have hallucinations, teens may reach for more pills to trigger them. This begs the question, “How many Benadryl tablets is too many?” It’s not clear, but what is being recommended in the video is certainly beyond the prescribed amount that any healthcare provider would endorse.

Diphenhydramine, the generic name for Benadryl, is an antihistamine commonly used to treat allergy symptoms or as a sleep aid. According to the data from the Johnson & Johnson (the manufacturer of the drug), the maximum 24-hour dose of Benadryl is 300 milligrams (mg). Each tablet usually contains 25 mg. According to the instructions, children between 6 and 12 should only take one tablet every four to six hours, but those 12 and older can take up to two tablets in the same time period. However, no one should take more than six doses within 24 hours. In therapeutic doses, diphenhydramine can be sedative, which is why it’s often used as a sleep aid. Many people who take it have sleepiness and feel groggy the next morning. Higher doses can cause agitation, confusion, increased body temperature, hallucinations, and even seizures. In addition, at these doses, it can affect the heart. Specifically, it can alter your heart rate by interfering with the refractory period between beats. This change in heart rate can be lethal. Symptoms of a Benadryl overdose are irregular heartbeats, excessive body heat, flushed skin, decreased sweat production, urinary retention, vision changes, inability to focus on your surroundings, delirium, and prolonged anxiety. Many of these adverse effects are because diphenhydramine isn’t just an antihistamine but also inhibits the effects of the neurotransmitter acetylcholine, which helps regulate blood vessel dilation, muscle contractions, and heart rate. Although it’s rare for someone to die from a diphenhydramine overdose, it can be lethal due to the drug’s effects on the heart, triggering a secondary health issue and its potential asphyxiation if someone loses consciousness and vomits. If someone overdoses on diphenhydramine, there’s really nothing you can do at home. While you can call the poison control center hotline for guidance (1-800-222-1222), the person will need emergency medical attention. Once at the hospital, they receive supportive care to keep their symptoms in check and, in some cases, a drug, physostigmine, which works by preventing acetylcholine’s normal breakdown, causing more of it to go into the brain’s synapses, countering the effects of diphenhydramine.

The “Benadryl Challenge” has many experts concern due to the potentially serious health issues it can cause. Officials at the Food and Drug Administration (FDA) issued a warning about it, saying, “that taking higher than recommended doses of the common over-the-counter (OTC) allergy medicine Benadryl (diphenhydramine) can lead to serious heart problems, seizures, coma, or even death.” The agency is also investigating any reports of teenagers ending up in emergency rooms or dying after taking part in the challenge. To prevent children and teens from accessing the medication, they’re recommending parents keep diphenhydramine and all other over-the-counter medications out of sight and reach. If needed, they encourage parents to lock up the medications to prevent them from misusing or accidentally overdosing. Since teens and children are home more right now because of the COVID-19 pandemic, they’re more likely to experiment, the FDA points out. Johnson & Johnson, the manufacturer of Benadryl, published its own warning on the drug’s website, “As with any medicine, abuse or misuse can lead to serious side effects with potentially long-lasting or even life-threatening consequences. We understand that consumers may have heard about an online ‘challenge’ involving the misuse or abuse of diphenhydramine. The challenge, which involves ingestion of excessive quantities of diphenhydramine, is a dangerous trend and should be stopped immediately.” A representative for TikTok said that the platform removed a small amount of Benadryl challenge material in May and has continued to monitor the site for any new videos. In their statement, they also said, “As we make clear in our community guidelines, we do not allow content that encourages, promotes, or glorifies dangerous challenges that might lead to injury.” However, as of September 1, 2020, if you look up “Benadryl Challenge” on the site, there were 18.5 million views.

It’s not just the “Benadryl Challenge” that parents should be worried about. There are many other challenges out there. Some challenges, like the ALS ice bucket challenge or the mannequin challenge, can be fun and don’t pose a significant threat. Unfortunately, other challenges, like the Benadryl challenge, are dangerous and can lead to permanent harm. Some of the most dangerous challenges in the past few years have caused serious injuries, and in some cases, death. The Tide pod challenge involves ingesting the laundry detergent pods. The Holocaust challenge encourages viewers to dress up like concentration camp survivors. The nutmeg challenge promotes overconsumption of the spice to cause hallucinations. The Blue Whale Challenge urges users to accomplish a certain task each day for 50 days. The tasks become increasingly difficult and, on the last day, participants are prompted to harm themselves and commit suicide. The Momo Challenge requires players to complete certain challenges and commit suicide at the end too. In this version, the participants are urged by a creepy character, a haunting image of a woman with long hair and bulging eyes. The Car Surfing Challenge involves hanging on to the top of a vehicle being driven by another person. The Kiki Challenge comprises getting out of a moving car and dancing to Drake’s “In My Feelings” while the car continues to move. The Bird Box Challenge has participants blindfold themselves while doing daily tasks. The point of the Fire Challenge is to set yourself on fire to test your endurance. The Pass-out Challenge (or the Choking Game) is designed to intentionally cut off oxygen to the brain long enough to have a short period of euphoria. Rooftopping is doing daredevil stunts across the top of tall buildings. The Gallon Smash is when someone pretends to fall on the floor with gallons of milk in their hands, resulting in the milk going everywhere. The Kylie Jenner Lip Challenge is to alter your lips so that they look like Kylie Jenner’s lips. Typically, it involves using a glass or a jar and sucking your lips to create a vacuum inside. The Skin Eraser Challenge is done by erasing the skin on your arms by continuously rubbing it with the eraser, resulting in a friction burn. The Banana Sprite Challenge is when a challenger has to eat a half dozen bananas and then drink 1 liter of Sprite. It can cause a chemical reaction in your stomach that results in death. The Sunburn Art Challenge is when you create a pattern on your body using sunscreen and then letting the sunburn the unprotected part. This increases your risk for skin cancer. Game 72 requires a player to be away from their house for at least 72 hours without their parent’s consent. The Boiled Water Bucket Challenge is just like the ice bucket challenge but involves boiled water instead. The Cereal Challenge involves using somebody else’s mouth as a cereal bowl. This means you fill their mouth up with cereal and milk and then eat out of their mouth. It’s a serious choking hazard.

Why are teens so interested in social media challenges? Teens are naturally more impulsive, so they’re likely to act before thinking through all of the consequences. This is actually the result of evolutionary biology. The teen brain is growing and changing rapidly to meet their needs. As they’re becoming more independent, they need to learn a lot of information quickly and the difference between good and bad choices. The other factor is the last part of the brain to develop is the prefrontal cortex. This is the part that helps control our impulses and avoid risk. It’s not until your mid-20s that it’s fully developed. Social attention lights up the reward centers in teens’ brains and releases the feel-good neurotransmitter, dopamine. Compared to the instant dopamine “hit” teens get when they get mass approval, working hard and doing well in school doesn’t supply that because they usually have to wait to see a grade. The other issue is social media idolizes outrageous behavior. So, the more outrageous something is, the bigger the bragging rights. Also, it’s a quick-moving environment causing teens to fear losing out. The addiction to attention from the masses is strong. While all teens are at risk, those who struggle with self-esteem issues and uncertainty about their place in the world are especially vulnerable. Peer pressure is a powerful force that no teen is immune to and while some kids are able to resist for a period of time, there’ll come a point in nearly every teen’s life that cave and follow the crowd. There’s a difference between a friend group egging each other on and a social media challenge with hundreds or thousands of anonymous people urging others to try crazy or harmful acts. This shouldn’t be surprising since social media platforms are designed to be addictive. Software algorithms send the “likes” received for a post at predetermined intervals to keep our attention focused on the screen. This causes us to continually check in to see how many we have. This is important to the social media companies because more time on the platform equals more exposure time to advertisements, which are the primary driver of cash flow. The other part of the problem is that we’ve trained teens to expect immediate rewards for their actions through our constant connectivity and need-it-now culture. Constant stimulus and reward cycles fill the majority of our waking hours.

As a parent, it’s important to understand why these challenges may have so much appeal and why teens may not fully appreciate the risks, so you can help your teens develop thoughtful, rational thinking skills. Parents should help teens understand that just because they have been “challenged” to do something doesn’t mean that they “need” to do it. To start a conversation, ask your teens about the biggest challenges they’ve heard about in their circle of friends. Use open-ended questions to encourage them to think through each step of the challenge. Ask them to contemplate the worst outcome versus the likely outcome. Talk about why they’d do it and if it would be worth it. Ask them what they think the best reward is for doing the challenges. Is it a bunch of likes? What is the real worth of these? Are they as good as physical rewards, such as good grades or a paycheck? Is it something they’ll be proud of in five, ten, or twenty years? Is a week in the hospital worth a few likes? The goal should be to (over time) help build the skill of judging risk. During conversations, you should listen as much as you talk. Also, don’t be judgmental because if teens feel judged, they’re less likely to listen to what you have to say. To encourage your teen to confide in you, you need to build trust. If you’re having trouble reaching your teen, ask for help. Teens don’t always listen to their parents but might listen to other adults in their lives. Following your teen on social media will help you to know what goes on in their day-to-day lives. Sometimes kids are more willing to talk about their peers than themselves, so ask questions about school trends, friends, and fads. This might provide you with more information than direct questions about their own activities. It’s essential to explain why internet challenges must always be discussed with a parent before a teen is allowed to do it. Be open and honest about your concerns. Show your teen examples of those whose lives have been changed because of participation in a harmful social media challenge. Teens might not want to talk about social media challenges with their parents, but the conversation can be quick, just be sure they know to be skeptical about what they see on the internet and don’t do anything dangerous.

Social media challenges can be fun and interesting, but they can also be dangerous. It’s parents’ job to help their kids navigate which ones are safe and those that aren’t. By doing this, they’ll learn the risk assessment skills that they’ll need for the rest of their life. In addition, there’ll be fewer injuries and deaths among teens from these “challenges.”