The AAP recommends that paediatricians ask certain questions for children and teens age 12 years and older. Photo: Nagy-bagoly Ilona/Dreamstime/TNS
Most young people who experience suicidal thoughts keep those thoughts to themselves. They might not bring it up on their own unless they are asked directly.
Any time your adolescent visits their paediatrician, for any reason, they may be asked a simple question “Have you been having thoughts of killing yourself or ending your life?”
The American Academy of Pediatrics recommends that paediatricians ask these questions for children and teens age 12 years and older.
It’s because paediatricians know that young people may have mental health concerns that they are not sharing with others. If your child shares that they are having suicidal thoughts, their paediatrician will ask more questions to help decide what to do next.
One strategy that your child’s paediatrician may recommend is to create a safety plan.
A suicide prevention safety plan is a written, personalised guide that your adolescent can use when they have thoughts of suicide.
A well-thought-out safety plan includes detailed descriptions of coping techniques to use during crisis moments. It also affirms your family’s commitment to making your living environment as safe as possible. Creating a safety plan in advance can help young people prepare to get through intense suicidal feelings.
There are different versions of safety plans. All plans share the same goal of keeping a person safe when they experience suicidal thoughts.
Your paediatrician or mental health professional can provide a template for a plan and work with you and your child to fill it out.
Plans come in printed and digital or app formats. Choose the one that works best for your adolescent. (The AAP does not recommend one plan over another.) If the safety plan is in a printed format, save a copy of it on your mobile phones. If you use a mobile app on your phone, be sure to keep printed copies so your adolescent can access it when they need it. A few examples include the Stanley Brown Safety Plan, My Safety Plan from the Child Mind Institute and Substance Abuse and Mental Health Services Administration Safety Plan.
Share a copy with trusted adults who are listed in your child’s plan and on their school health team so they can support your child.
Talk with your child about their safety plan. Remind them that it is a personal tool that they can turn to whenever they feel overwhelmed, hopeless or desperate.
Ask them to describe when they would use it. Check in regularly to see if the safety plan needs to be updated.
Begin with listening
Creating a written safety plan begins with listening and learning. For many young people, suicidal thoughts do not happen “out of the blue.” There are usually signs or triggers. Coping with these triggers becomes easier if you see these signs early and act. Your child will work with their paediatrician to personalise the safety plan to fit their needs.
Their safety plan will include the following information:
> Inner signals that let your child know it’s time to follow the plan. These could include feelings of overwhelming sadness (despondence), a sense that life will never get better (hopelessness) or actual thoughts of killing themselves.
> Outer signals that parents and others might notice. For example, you might observe that your child is always irritable. This may include intense reactions that do not match the situation, or the need to be very careful not to upset or offend them. Or, they might withdraw, pulling away from friends and family. When you see these signs, it’s time for your child to use the tools in their plan.
> Coping strategies your child will use. Encourage coping strategies such as deep breathing, listening or dancing to music, creating art, guided imagery, going for a walk, or cuddling with a pet. These should be actions that they can use to distract themselves until the distressing thoughts pass.
> People who offer a healthy distraction and/or help during a crisis. Sometimes, coping strategies are not enough in the moment. It’s important for your child to have people they can reach out to for help. This could be a trusted friend, family member, teacher, coach or counsellor – someone who cares about them and can listen to them offload. In moments of crisis, children (and adults) need to feel seen, heard and understood.
> Make sure your child has a backup plan, in case their immediate circle of friends or family aren’t available. Adolescents need trusted adults who can help and guide decision-making during a time of crisis. They can add a few trusted adults to the list, along with their contact information.
Keep home safe
The steps above focus on ways to protect your adolescent during a mental health crisis. You can also take precautions to help ensure their home environment is safe.
This is important, since most people who try to injure themselves do so impulsively. Remove items that could be used for self-harm in the moment.
Mental health providers and paediatricians may ask your child about their safety plan at each appointment. The goal is to make sure that the plan still fits their needs and will keep them safe.
If adjustments are needed, they can be worked out in partnership with your child’s paediatrician or mental health provider with your input.
You can have routine conversations about mental health. Just like you talk about physical fitness, you can talk about mental fitness with your child.
These regular check-ins throughout their childhood, adolescence and into adulthood help show that it’s normal and healthy to talk about feelings. They also give you a chance to notice if something seems off.
You can’t fix everything for your child, but you can be there for them. Just listening without judgement, offering a reassuring hug or sitting quietly beside them can help them feel seen, heard and understood. – American Academy of Pediatrics/Tribune News Service
Dr Theresa T. Nguyen is the chair of paediatrics at the Greater Baltimore Medical Center and an assistant professor of paediatrics at Johns Hopkins School of Medicine. She practices integrative medicine, a whole-person approach to healing, incorporating all aspects of lifestyle (mind-body-spirit, nutrition, sleep) in partnership with her patients and families. She is passionate about integrative physical and mental well-being. She is the Maryland American Academy of Pediatrics (AAP) Ambassador for Youth Suicide Prevention and Trauma Informed Care and a member of the AAP Section on Integrative Medicine. She has published two TEDx talks, and “Why Young Adults Don’t Need Your Advice “ was a TEDx Editor’s Pick.
Those suffering from mental health issues or contemplating suicide can reach out to the Mental Health Psychosocial Support Service (03-2935 9935 or 014-322 3392); Talian Kasih (15999 or 019-261 5999 on WhatsApp); Jakim’s Family, Social and Community care centre (011-1959 8214 on WhatsApp); and Befrienders Kuala Lumpur (03-7627 2929 or email sam@befrienders.org.my).
