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