Pediatric emergency medicine trisk 4177 4177
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Clinical Considerations
Suicidal behavior involves thoughts or actions that may lead to self-inflicted
death or serious injury. A distinction is made between suicidal ideation and
suicidal attempts in which deliberate attempts to take one’s life occurred.
The increasing trend toward suicidal behavior by children and adolescents is
alarming ( Table 126.10 ).
Clinical Recognition
Table 126.11 indicates the high-risk situations for suicidal behavior in which
direct questioning about suicide should occur. The first two situations
immediately alert the physician to the danger of suicidal behavior. The other
situations involve a different chief complaint, masking possible suicidal
ideation or behavior. All ingestions that are not clearly accidental,
intoxicated drivers, drivers involved in single vehicle crashes, and patients
who present with trauma from engaging in high-risk behaviors should be
screened for suicidal behavior. Overtly depressed children, depressed
children who present with somatic complaints, and children who have acted
violently are also at risk. Psychotic children present a special problem and
may present with inadvertent suicide attempts as the result of impaired
judgment, hallucinations, and delusions of persecution. The isolated,
withdrawn child may harbor suicidal thoughts that are uncovered only by
direct questioning.
