Pediatric emergency medicine trisk 4179 4179
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TABLE 126.11
CHILDHOOD AND ADOLESCENT SUICIDE: HIGH-RISK
SITUATIONS FOR SUICIDE ATTEMPTS
Suicide attempt just made
Suicidal threat made
“Accidental” ingestion
Child complains of depression
Psychotic child
Significant withdrawal by child
History of aggressive or violent behavior
History of substance abuse
History of previous suicide attempt(s)
Medical concerns, but child appears depressed
Highly lethal method of suicide attempt
Availability of or access to firearms
In school-aged children, certain risk factors have been identified that
distinguish children with suicidal behavior from other children with
emotional problems ( Table 126.12 ). Suicidal children are likely to be
depressed and hopeless. Self-esteem is low, and they see themselves as
worthless. The want to die is present, as are preoccupations with death. The
family history may include past episodes of parental depression and suicidal
behavior. Suicidal children tend to view death as temporary and pleasant
rather than irreversible.
Assessment
All patients require a thorough medical assessment in order to identify and
treat any potential physical sequelae. Consider obtaining urine toxicology for
drugs of abuse and serum screens for acetaminophen and salicylates on all
suicidal teenage patients, as a concealed ingestion may be present or the
patient may be self-medicating with drugs of abuse.
