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 pediatrician, 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 pediatricians ask these questions for children and teens age 12 years and older. It's because pediatricians 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 pediatrician will ask more questions to help decide what to do next.

One strategy that your child's pediatrician may recommend is to create a safety plan. A suicide prevention safety plan is a written, personalized 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 pediatrician 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:

--Stanley Brown Safety Plan (app option)

--My Safety Plan from the Child Mind Institute (app option)

--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.

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 pediatrician to personalize 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 counselor—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.

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 kill themselves do so impulsively. Remove items that could be used for self-harm in the moment. Examples include guns, knives, razors, cords or other items used for tying or binding, or pills (prescription and non-prescription).

The 988 Suicide and Crisis Lifeline is available 24 hours a day, 7 days a week. This is the MOST important public resource to include in a safety plan. The 988 Crisis Line has trained counselors who are always available to listen, provide resources and send out a mobile crisis team—even in the middle of the night. The safety plan can also include nearby places to go for urgent help, such as the nearest hospital emergency department or mental health crisis center.

Mental health providers and pediatricians 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 pediatrician 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 judgment, offering a reassuring hug or sitting quietly beside them can help them feel seen, heard and understood.

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Theresa T. Nguyen, MD, MS, FAAP is the chair of pediatrics at the Greater Baltimore Medical Center and an assistant professor of pediatrics 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 wellbeing. 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; "Why Young Adults Don't Need Your Advice " was a TEDx Editor's Pick. Her pediatric and wellness expertise has been featured on local and national television and print media. She enjoys yoga, trail walks with her dog, flower arranging and eating and traveling with family and friends.

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