September is Suicide Prevention Awareness Month and knowing the warning signs and when to get help can be crucial to helping a child dealing with a mental health crisis.
Dr. Ekaterina Stepanova, our chief of child and adolescent psychiatry, answers 7 questions about how to approach the sensitive topic with the kids you care about.
What signs should you look for if you’re worried your child may be suffering from depression or having suicidal thoughts?
You should watch for changes in mood, such as frequent sadness, irritability or anger that doesn’t seem to improve. You may also notice changes in sleep, appetite or energy levels. Some children become more isolative, spending much more time alone and may stop enjoying activities they once loved.
A child who suddenly withdraws from friends or family may be struggling. Expressions of hopelessness, guilt or statements like “life isn’t worth it” are also warning signs. Some kids talk about death, joke about suicide or even give away possessions. Trust your instincts if something feels off.
What are the first steps you should take if you observe those signs in your child?
The most important step is to start a calm and supportive conversation. Ask your child directly how they’re feeling and listen without judgment or rushing to “fix” things right away. Let them know it’s okay to talk about difficult feelings and that you want to help. Then, reach out to a professional—your pediatrician, school counselor, a child psychiatrist or psychologist—for an evaluation. If your child expresses thoughts of suicide and hasn’t yet established care with a mental health professional, go to the nearest emergency room or a walk-in mental health clinic.
Can you explain the difference between suicidal ideation and suicidal behavior?
Suicidal ideation means having thoughts about suicide, which can range from vague wishes not to be alive to detailed plans to hurt yourself. Suicidal behavior, on the other hand, involves actions—such as researching methods, preparing to act or attempting suicide. Both are serious, but suicidal behavior indicates an imminent risk. Parents should not assume that “just thoughts” are harmless, since ideation can quickly progress. Talking openly about suicidal ideation helps children feel heard and supported.
What does it take for suicidal thoughts to progress into a suicide attempt?
Suicidal thoughts can turn into attempts when a young person feels overwhelmed by emotional pain and can’t see another way forward. Stressful life events—like bullying, relationship problems or academic struggles—can add to this risk, especially if the child already has depression or another mental health condition. Access to lethal means, like firearms or large amounts of medication, greatly increases the chance of harm. Feeling isolated or unsupported can also push thoughts into action. This is why connection, support and safety planning are so important.
How do you treat a teen who may be suicidal?
Treatment begins with a thorough mental health evaluation to understand the child’s specific struggles. Therapy, like cognitive behavioral therapy (CBT) or dialectical behavior therapy (DBT), helps teens learn coping skills and new ways of handling overwhelming emotions. Parents are often involved, since family support is a critical protective factor. Sometimes medication is used to treat underlying depression or anxiety. Safety planning is also essential, this means identifying warning signs, building coping strategies and removing access to harmful items. With the right help, teens can recover and go on to thrive.
What things should you not say when you’re helping your child through a mental health crisis?
It’s important not to dismiss or minimize your child’s feelings. Saying things like “you’re just being dramatic” or “what do you have to feel sad about” can make them shut down. Avoid giving simple solutions like “just cheer up” or “think positive,” which can feel invalidating. Don’t argue about whether they “really mean it”—instead, take all statements seriously. The best approach is to show that you believe them, you care and you’re ready to get help together.
How should you handle it when your child’s friend or family member dies by suicide?
This is an incredibly painful situation, and children may feel confused, guilty or scared. Parents should use clear, age-appropriate language. Explain that the person died by suicide, and it was not the child’s fault. Encourage your child to talk about their feelings and ask questions, even if you don’t have all the answers. Keep routines as normal as possible to provide stability. Some children may need extra support from a counselor or therapist to work through their grief.
Talking about suicide does not make a child more likely to attempt it. In fact, asking about these thoughts shows care and can bring enormous relief. Every child deserves to feel safe and supported, and help is available. If you’re ever unsure, it’s better to ask and to seek professional guidance than to hope the problem will go away. And most importantly, you don’t have to handle this alone. Reaching out for help is a sign of strength, not weakness.