Suicide is one of the leading causes of death in children younger than 12 years and is the fourth leading cause of death in 12 year olds. Increasing numbers of young children now present to the emergency department (ED) with mental health issues, and ED personnel must determine the most appropriate disposition options for these children, sometimes without the assistance of specialty mental health services. Much of the present body of literature describing suicidality fails to separate children from adolescents for analysis and discussion. This article reviews relevant literature pertaining to suicidal thoughts and behaviors in young children and discusses problems with available data, as well as epidemiology, risk factors, typical motivations, methods, assessment, and disposition for these patients. Suicidal children younger than 12 years are often clinically different from suicidal adolescents and adults and may require unique assessment and disposition strategies in the ED. A child who has ideation without a clear plan, or has made an attempt of low lethality, can sometimes be discharged home, provided that a supportive, responsible caregiver is willing to monitor the child and take him or her to outpatient mental health appointments. If the home environment is detrimental, or the child has used a method of high potential lethality, inpatient treatment is the most appropriate course of action. Mental health specialty services, when available, should be used to help determine the most appropriate disposition. ACADEMIC EMERGENCY MEDICINE 2007; 14:810-818 ª 2007 by the Society for Academic Emergency MedicineKeywords: child suicide, intentional self-destructive behavior, youth suicide, intentional death, suicidal children F rom both a child safety and an emergency department (ED) perspective, suicidal behavior in young children is a concern. This phenomenon is more frequent among children younger than 12 years than previously realized. [1][2][3][4] It was once assumed that young children were not capable of either contemplating or performing suicidal acts; however, a growing body of research has shown that young children do plan, attempt, and successfully commit suicide. 3,[5][6][7] This article addresses several issues, including problems with defining and determining the rates of childhood suicide, relevant risk factors, methods of suicidal behavior, and strategies for assessing suicidality in this population. We also suggest strategies for disposition for this special population group.Such information is important for emergency physicians and other personnel who will likely encounter prepubescent children at risk for suicidal behavior. Increasing numbers of children now present to the ED with mental health issues. 8 In addition, the rate of ED visits for attempted suicide for children younger than 14 years is comparable to the rate of visits for individuals aged 50 years and older.9 ED personnel are increasingly charged with determining the most appropriate disposition options for these children, someti...

Unresolved issues of ethical, methodological, and legal concerns in the use of normal healthy volunteers persist. Financial incentives in their recruitment offer a unique ethical dilemma because of questions surrounding payment. A review of literature was conducted to obtain research systematically examining volunteer motivation and the role offinancial incentives. The primary selection criterion was motivation and payment to volunteers; seven studies met the criterion for review. Studies that have systematically investigated volunteer motivation have found financial rewards to be an important motivator among normal healthy volunteers in their decision to participate in clinical trials. Also evident is that differences based on demographic characteristics exist in the motivation and rates of volunteerism. Ethical issues surrounding the use of normal healthy volunteers are discussed, with attention to the issue offinancial incentives (e.g., economically vulnerable volunteers, undue inducements). Regulations, guidelines, and recommendations are discussed with regard to volunteers and financial incentives.

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Unresolved issues of ethical, methodological, and legal concerns in the use of normal healthy volunteers persist. Financial incentives in their recruitment offer a unique ethical dilemma because of questions surrounding payment. A review of literature was conducted to obtain research systematically examining volunteer motivation and the role offinancial incentives. The primary selection criterion was motivation and payment to volunteers; seven studies met the criterion for review. Studies that have systematically investigated volunteer motivation have found financial rewards to be an important motivator among normal healthy volunteers in their decision to participate in clinical trials. Also evident is that differences based on demographic characteristics exist in the motivation and rates of volunteerism. Ethical issues surrounding the use of normal healthy volunteers are discussed, with attention to the issue offinancial incentives (e.g., economically vulnerable volunteers, undue inducements). Regulations, guidelines, and recommendations are discussed with regard to volunteers and financial incentives.