Suicidal Ideation in Very Young Children

Blog written by Shoshana J Fagen, PsyD – September 2021

Back at the beginning of my career, part of my job was to consult for a head start program. The majority of the referrals were for 4-year-olds who wouldn’t lay still during nap time or for 3-year-olds who were hitting their friends. However, the referral that stands out the most was for a 4-year-old girl who had made a series of statements that her teachers found very alarming. Throughout the first few weeks of her enrollment, she made statements about wanting to be dead and wanting to kill herself. Her teachers were right to be concerned. According to the CDC, suicide is the third leading cause of death among children ages 5 to 14. Though it is highly uncommon to hear a 4-year-old expressing thoughts of suicide, such statements should never be ignored.

There are usually only two reasons young children express suicidal statements: they’ve heard someone at home regularly make these statements, or they cannot handle the intense, emotional turmoil they’re experiencing. In both situations, such statements are quite serious and indicate that the child is experiencing unusually strong, negative emotions, requiring the support of professional mental health services.

In a minority of cases, a young child may express suicidal statements because they hear someone at home regularly make similar statements. In this situation, the child has learned, through modeling, that saying these things is the appropriate way of handling strong, negative emotions. It is important for both the child and their family to receive counseling, as someone within the home is likely in a large amount of emotional pain. I have seen many situations where parents who are struggling with their own mental health needs are resistant to seek out services. They feel that they should commit whatever limited time and emotional resources they have left to the task of parenting, instead of going to therapy.  Though well-intentioned, caretakers struggling with mental health needs should always try to make time for their own mental health care. A caretaker cannot fully be there to support their child’s needs if they neglect their own needs first.

Though it can be hard to imagine, very young children can experience true, suicidal ideation. They tend to make these statements during a time when they believe that being dead would be better than living through the emotional turmoil they are currently experiencing. Because young children do not have the same capacity for planning and preparing as older children and adults, suicide attempts among this population are often seen as impulsive actions. As a result, there are an unknown percentage of childhood deaths in the United States that are ruled accidental but were, in fact, purposeful and impulsive deaths by suicide. Because of this, it is particularly important to take suicidal statements from young children seriously, as that is often the only kind of warning sign given that a child may be in a significant level of distress.

One may ask, ‘how can I tell if a child making a suicidal statement is truly suicidal?’  Hearing a young child say, “I want to kill myself,” is alarming, and it can be easier to hold onto the hope that this child is perhaps just repeating something they heard at home. The truth is that it doesn’t matter – all suicidal statements should be taken seriously. It is extremely important to understand that giving suicidal statements attention does not make the thoughts worse, and asking children if they have thoughts of suicide will not make them consider it. In fact, a main contributing factor towards suicidal ideation is a feeling of isolation. By directly asking children about these thoughts, you are decreasing that sense of isolation and helping them feel less invisible.

Throughout my career, I have asked many young children if they have thoughts of suicide. Most look at me as if my head had suddenly turned bright purple and give me a very honest, “no, why would I want to be dead?” On occasion, a child will answer “yes.” Sometimes a caretaker has already heard such statements from their child, and there are times when the caretaker has an urge to minimize this response by jumping in and adding, “but he doesn’t really mean it, do you, Billy?”  It is important to know that, by minimizing a child’s response about their suicidal ideation, you are invalidating the child’s feelings and continuing to make them feel isolated and invisible. Similarly, caregivers should work with mental health professionals and try to be as open as possible when talking with their child about suicide. Insisting that their child has never had any suicidal thoughts, for example, is also harmful as it can make that child feel like they were not supposed to share any suicidal thoughts they may be having, and should not do so in the future.

So now that this topic has been brought to your attention, you may be wondering how you are supposed to respond if a child ever makes a suicidal statement to you or in your presence. There are a few important steps to take in these situations.

1. Validate – the first and most important step is to validate the child’s feelings that underlay the suicidal statement. This could be saying something like, “I am sorry to hear that you are feeling bad right now, and that you think it would be better to be dead.” or “you must feel pretty bad inside if you want to be dead.”
2. Give Space – give the child space to talk about why they are feeling this bad. An appropriate follow up question could include, “do you want to tell me a little about what is going on?”
3. No Secrets – a suicidal statement is a serious matter, and it is important to not make the mistake of promising to keep any secrets about these statements. It is very likely that you will have to share these statements with someone else, whether they be the child’s parent or a healthcare provider.
4. Get Help – suicidal statements made by someone of any age should always be taken seriously. If you are a childcare provider, it is important to alert the child’s parents/caregivers and advise them to seek out mental health services. As a parent/caregiver, you should work to seek out mental health services for your child as soon as possible. A good place to start is by talking to the school’s counselor or asking the pediatrician if they have any in-house mental health services.

You don’t need to have the answers right away, but by being there and listening to your child you can make them feel more at ease and able to express their feelings in a safe space.