The girl is said to have tied a belt around her neck as part of the challenge, which encourages people to try and pass out by restricting their airflow. Another variant of the challenge—called the Pass Out challenge—encourages people to shake their heads until they pass out.

Blog Sicilia reports that investigators believe that the child had previously taken part in the challenge, with the aim of not breathing for as long as possible.

The Blackout Challenge, which is also known by other names such as the Choking Game or the Fainting Game, did not originate on TikTok and has been around for years.

TIME magazine reported in 2018 that between 1995 and 2007, 82 children between the ages of six and 19 died in the U.S. after playing the so-called game.

While children and teenagers used to hear about the game through friends, variants of the game have been posted on social media sites like YouTube in recent years. The challenge was a trend on Snapchat and Instagram in 2014, as reported by the Irish Examiner.

However, the girl’s death seems to suggest that the game is still circulating on TikTok as the “Blackout Challenge” or the “Pass Out Challenge” after it initially became a trend on the app around a year ago.

Hashtags related to the challenges seem to be blocked so it is unclear how many videos have recently been posted to the app, as they have likely been taken down.

TikTok told Newsweek: “Our deepest sympathies are with the girl’s family and friends. We do not allow content that encourages, promotes, or glorifies dangerous behavior that might lead to injury, and our teams work diligently to identify and remove content that violates our policies.

“While we have not currently found evidence of content on our platform that might have encouraged such an incident off-platform, we will continue to monitor closely as part of our continuous commitment to keep our community safe. We will also assist the relevant authorities with their investigation as appropriate.”

The Mayor of Palermo, Leoluca Orlando, said in a statement: “I am in shock, as I think the whole city is in shock, for the tragedy that today saw a child victim of ‘social challenges.’

“A tragedy that questions us. It questions us about the relationships between young people mediated by smartphones, about the social role that we are increasingly delegating to new technologies, about the fragile but powerful relationship that more and more young people and adults build and perhaps suffer with their digital devices.”

Orlando also said: “I believe that a reflection on these issues by all of us can no longer be postponed, even more so at a time when the pandemic has increasingly pushed us towards digital communication, making us appreciate its undisputed potential and positivity.”

The Mayor also said that flags would be flown at half-mast in municipal buildings and that schools would participate in a minute of silence.