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suicide attempts as the result of impaired judgment, hallucinations, and delusions of persecution The isolated, withdrawn child may harbor suicidal thoughts that are uncovered only by direct questioning