At first, it looked like one of those accidents that first prompted companies to invent child-proof caps. Aaron, an active, tow-headed five-year-old, climbed onto the side of the bathtub in the family home, then to the sink, reached for the aspirin bottle, and swallowed 47 pills. He left only one tablet in the bottle, he later told an emergency room doctor, “for his mother.” But it didn’t take long for the doctor to realize that something else entirely was going on.

According to the intake notes, Aaron went on to say that he’d been angry that his siblings wouldn’t play with him, and that he had taken the aspirin because he “had a toothache and wanted to die and talk to Jesus.” Aaron also mused about other ways of dying, asking the doctor if he would be killed if he jumped out of the window, and said he wanted to die so he could see his maternal grandmother, who had passed away six months before.

The suicide attempt of Gregory, also five, and Black, initially looked like an accident as well. While playing at being Spiderman, he wrapped a curtain string around his neck and jumped from the bed. The emergency room doctor began to consider a different motivation when Gregory volunteered the information that his father had taken his life when he was a baby and that he had often heard relatives talking about the death.

A Poorly-Understood Problem

It may come as a surprise—and shock—to many that a child that young could even begin to contemplate ending his or her own life. And in fact, until relatively recently it was believed that children under the age of puberty simply “couldn’t” commit suicide, both because they had an incomplete understanding of the permanence of death and because young kids couldn’t be depressed in the way we think of depression.

“When I was in grad school in the late 1980s, we were taught that kids didn’t have the cognitive development to get depressed,” says David Palmiter, PhD, ABPP, a professor of psychology at Marywood University in Scranton, Pennsylvania. “We now know that was very untrue—they do. You can have kids under the age of 12, even under ten, thinking about attempting or even completing suicide.” And while a very young child may not fully grasp the “foreverness” of death, the end result is still either an attempt or a death by suicide, says Carl Tishler, PhD, ABPP, an adjunct associate professor of psychiatry at The Ohio State University. “Any act that results in the child’s death that’s a self-act is a form of suicide,” Tishler says.

Even more disturbing, such deaths are on the rise, according to several recent studies. The Centers for Disease Control and Prevention (CDC) reported in 2017 that between 1999 and 2015, one child under age 13 died of suicide nearly every five days, on average; and that the frequency rose between 2013 to 2015. 1

Separate research the same year, published in Pediatrics in 2018, found that the number of children ages five to 17 hospitalized for suicidal thoughts or actions in the US had doubled over the previous decade.2

“The most recent CDC database, based on surveys between 2017 and 2019, shows that in ages ten to 14, suicide moved from third-ranked to second in causes of death,” says Palmiter. “Only accidents caused more deaths.”3 He adds that in ages five to nine, rates are much lower, not even registering in the top ten causes of death—but that also means suicide in those ages is even more poorly understood.

Suicide Triggers in Children

Here’s what has emerged so far about what might trigger such youthful suicidal thoughts or actions, and how to be alert to the warning signs in your child. Both studies and clinical observation have found that certain events or situations can act as triggers for young children who might be especially vulnerable.

Any of these can pose a danger:

Time of Year. The 2018 Pediatrics study that analyzed hospitalizations for suicide ideation or attempts found a striking phenomenon: a huge difference from month to month in the frequency of hospital admissions, with the lowest being July, and numbers creeping back up when school starts.2 This could be due to anxieties around school, including bullying, but there may be other more subtle factors at work as well, says Palmiter. “Studies where teens and children rate their stress find it’s lower in the summer, and while school is one element, there is also less light and less outdoor time during the fall and winter,” he says. “Kids can have a strong reaction in mood to both of those, including the lack of physical activity.”

Domestic Violence. Not only is intimate-partner violence in a given household extremely common—in the US one in four women, and one in seven men, are the victim of severe physical violence by an intimate partner in their lifetime—but it is the number-one predictor of suicidal thoughts or actions in children, says Tishler. And since the coronavirus pandemic, rates of intimate violence have risen. “It’s not the only correlate—certainly growing up with an alcoholic parent, for instance, is terribly stressful—but it’s the strongest one,” Tishler says.

Death in the Family. This could mean, as in Aaron’s case, the loss of a relative, but even the death of a pet can be devastating to a young child, says Tishler. “Pets can offer what we call unconditional positive regard to a child,” he explains. “The child can talk to the pet, and the animal will be nice back—and not ask questions. They might sleep with their pet. Losing it can be really difficult to work through, and it can be easy for a parent to minimize that.”

Other Suicides. “Suicide can have a sort of copy-cat effect,” says Tishler. So hearing people talk about suicide, whether someone close to the family or even in the world at large, “can glamorize it in a way. For example, if dear Uncle Jed hung himself, and it’s talked about a lot—‘we loved him so much, why would he do that?’” Suicide has been shown to “run” in families, and while a genetic predisposition to depression may play a role, so also may simply the awareness that someone else chose that outcome.

Race. A study in Pediatrics in 2016 found that 37% of five-to-11-year-olds who died by suicide between 2003 and 2012 were African American—a far bigger percentage than whites based on population—and in a study from the previous year found that the rate in that demographic group had doubled between 1993 and 2012. 4,5

That comes as no surprise to Palmiter, whose wife and (now-adult) children are Black. “The problems with implicit bias and explicit racism are absolutely crushing,” says Palmiter. “It’s nonstop. Schools don’t know how to begin to think about it, nor does society. That’s a mighty and terrible stress.” Researchers also speculate that many Black families may have less access to health care in general, and mental-health care in particular.

[Click to Read: The 10 Biggest Barriers to Black Mental Health]

Gender. As with teens and adults, more male children commit suicide than females: In the 2017 CDC survey, 76% of those under 13 who committed suicide were male. But there is some evidence that, also similarly to older age groups, more females may contemplate or attempt suicide, but more males actually succeed at carrying it out. And in another alarming trend, the 2018 Pediatrics study of hospitalizations for suicide attempts also found that while there were increases among both girls and boys, they were higher for girls.

Social Media. While the oversized impact of 24/7 virtual social contact is clearer in older children and teens—and research into its use in younger children is scant—there is no question that increasingly younger children are becoming wrapped up in its influence. The ubiquity of social media also tracks with the rise in youth suicide, so it may have a role in precipitating crises, especially as a conduit for cyber-bullying. “The influence of social media is so pervasive, and it’s changing so fast, that we’re still catching up to what it means,” says Palmiter.

Coronavirus and COVID-19. Rates of mental health issues among adults due to the current pandemic are skyrocketing, to the point where “it’s now normative to be depressed or anxious,” says Palmiter. Meaning: It’s more common to feel this way than not. In a recent Census Bureau survey, 57% of adults reported being depressed at least several times a week, and 69% felt significant anxiety several days or more a week. “The Census isn’t surveying kids under 18, but it would be a shock if that’s not the case for children as well,” Palmiter says. “And we have anecdotal evidence that COVID-19 is making bullying a bigger problem.”

Case in point that dovetails social media and pandemic: Palmiter cites a child on a sports team who tested positive, leading to all sports being shut down and everyone quarantined. “On social media, that kid was eviscerated,” he says.

Signs and Signals That May Spell Trouble

How to protect your child? First, it’s highly unlikely that even the most verbally sophisticated nine-year-old is going to come to you and say, “Mom/Dad, I’m depressed.” One of the most difficult aspects of dealing with suicidal impulses among the very young is the unlikelihood that they will directly or clearly verbalize their distress.

Not only may they not be self-aware enough to do so, says Palmiter, but they may also dread that their parent will take action, like pushing them to see a therapist or talking to the school. Another barrier? Parents’ own denial.

[Click to Learn More About the Subtle Suicide Warning Signs in Children]

“As parents, we’re lunatics for love, we’re crazy people, and no engaged parent is happier than when their children are happy,” Palmiter says. “So in study after study, parents underestimate their kids’ suffering. They tell themselves: it’s just a rough patch, they’ll come out of it, I went through this too.”

He advises thinking of your child’s mental health like their dental health: If your kid had a bad toothache, you’d take him or her right in, not feel that it will go away or that it’s a reflection on you as a parent. “Most kids who could benefit from mental health care don’t get it,” says Palmiter, but he feels that cognitive behavior therapy, in particular, can be extremely helpful in giving children tools to deal with distress or overwhelming feelings.

Five Worrisome Behaviors to Watch

In general, keep your eye out for these kinds of statements or behaviors:

#1. Sleep or Appetite Disturbances. “You may have to do a little spying,” says Tishler. “Your young child may be up late talking on the cellphone, or looking at social media.” That could increase—or indicate—anxiety, and can also lead to behavioral issues like outbursts of temper or crying spells. Loss of appetite is a sign of distress in children and adults alike.

#2. Negative Self-Talk. A depressed child will take every setback as a sign of their inherent unworthiness, and successes as a matter of “luck” or external circumstances, says Palmiter. So if your child gets a low grade and talks about it like “I’m just stupid” or “it’s never gonna change,” and a good grade is because “the teacher was in a good mood,” pay attention.

#3. Any Self Harm. Young children may not exhibit self-harm like cutting, which is more common among adolescents, but may find other ways of hurting themselves. “I’ve seen a child who has taken an eraser and rubbed it so hard on the skin as to leave a scar,” says Tishler.

#4. Impulsivity or Attention-Deficit Hyperactivity Disorder. These two tend to go hand in hand, and research shows that having been diagnosed with ADHD is a particular risk factor for suicide in children ages five to 11 (depression was a more common risk factor in those ages 12 to 14). Younger children may be more susceptible to responding impulsively to problems, especially if there is an extra trigger like a death in the family or domestic violence in the home.

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#5. Not Hitting the Usual Marks. This could refer to school—not necessarily grades, but general functioning and socializing, or activities of daily living like physical activity or grooming, says Palmiter. Studies have shown that signs like withdrawing from friends or school activities, giving away their possessions, or generally being increasingly aggressive, irritable, or unhappy for an extended period should all be addressed by parents.

How to Help Your Child

Cognitive behavioral therapies have been shown to be very helpful even in young children—but first, you have to get your child to a professional. Tishler always starts by having parents get a thorough physical check-up for their child, including looking at their eyesight, learning disabilities, thyroid function (thyroid dysfunction can contribute to anxiety or depression), and any other possibilities.

One great advantage of bringing in professionals is that parents can also learn techniques for talking to their child in a way that leads to greater openness. “The therapist has to figure out how to help the small child put their feelings into words, rather than taking [self-destructive] action or going into fantasy, as in, ‘I could go to heaven and avoid this pain,’” says Tishler. Parents can then continue that work on a daily basis.

Experts also recommend talking to your child and checking in with them frequently about their feelings. Asking your child if they feel so bad they think about dying or wish they could go to sleep and not wake up will not introduce the concept of suicide to them or cause them to become suicidal. Talking helps them to understand and process their feelings and emotions.

For more information or to be connected to local support groups and other suicide-prevention initiatives, contact The National Alliance on Mental Illness and the American Foundation for Suicide Prevention. The Suicide Prevention Resource Center has put together a list of resources other helpful suicide-prevention information for parents and families.

[Read This Next: How to Find Affordable Therapy]

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Last Updated: Sep 29, 2020