Pediatric emergency medicine trisk 4181 4181
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child. (What did the child think or hope would happen? Did the child take all
the pills that were available? Did he or she expect to wake up? Did he or she
tell anyone after taking the pills? Did he or she leave a suicide note? Now
that he or she is awake, is the child pleased or displeased to be alive? Does
he or she intend to try again?)
Children who threaten suicide without making an actual attempt should
also be questioned carefully about suicidal intent. (How long has the child
considered suicide? What methods? When will this take place? Previous
attempts? How about other family members?) Psychotic and depressed
children, especially when the parents appear unable to supervise the child,
should elicit particular concern.
Assessment of the child’s level of impulsivity is also important ( Table
126.16 ). Does the attempt appear to have been impulsive rather than
planned? Is there a history of prior impulsive behaviors? Is there evidence of
impulsivity during the ED interview?
TABLE 126.14
CHILD AND ADOLESCENT SUICIDE: ASSESSING MEDICAL
LETHALITY
Vital signs
Level of consciousness
Evidence of drug/alcohol intoxication (e.g., pupils, smell on breath)
Need for emesis, lavage, or catharsis
Acute medical complications (cardiac, respiratory, renal, neurologic)
Indications for medical hospitalization, including intensive care
Residual abnormalities
