In pediatrics, we are accustomed to having the joy of seeing children grow and mature. Oftentimes, families allow us to share in both small and large accomplishments over the years that we see them. It makes sense then that we might also be the place a family turns to in times of difficulties or even tragedies. Sometimes all that is needed is a comforting word or reassurance, but other times require more thoughtful insight and discussion. Being aware of the risk for pediatric suicide and attempting to screen for a child at risk is one of these situations.
Looking at literature discussing pediatric suicide reminds us that many victims have contact with a primary care physician shortly before an incident takes place. It is certainly more likely in the pediatric population that a child or family will have contact with their primary care physician than the ability to see a mental health professional. This type of access encourages pediatricians to remember their multifaceted role. They must take the time to notice not only a patient’s physical presentation but also his affect and social circumstances. There are several risk factors that are generally acknowledged to put a pediatric patient at higher risk for suicide. This list includes, but is not limited to:
Death of a friend or family member
Change in general self esteem
Family history of violence or abuse
High rate of suicide in community
Inadequate social resources
Of course these are difficult topics to discuss. Pediatricians and parents must be alert and pick up on often subtle clues that may help a child before they put themselves in danger. General and open ended questions may be asked to try and allow the child to reveal details that might not spontaneously come forward during an office visit. Some standard questions physician ask are:
Although these questions may seem vague, they might reveal a layer of emotion or conflict that can give the pediatrician or parent a chance to ask for more detail or bring up other topics. If a child is in danger emergent psychiatric evaluation may be warranted and follow up is key. Considering these topics and their possible answers and outcomes is something none of us looks forward to. But by handling them openly and honestly, a child might be prevented from taking an irreversible step for a very reversible problem.