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"One more accident and that ought to do it," Brian, aged 9 years, remarks in one of many arresting case examples in an impressive book. A monograph that discusses virtually every aspect of self-destruction in children, The Suicidal Child is balanced in its emphasis: psychoanalytic, cognitive, and psychopharmacological aspects of the problem and its treatment each receive equal time. Devoted to suicide in childhood, the work avoids the common error of labeling all patients younger than 19 years as "children," so this is not a book about the more common problem of adolescent suicide. Nevertheless, its lucid explication of the problem in childhood is of value to anyone interested in suicide prevention at any age.
As Brian's comment suggests, children can contemplate self-destruction even at an early age. Whether or not we believe younger patients understand death's permanence, we can surely agree with Pfeffer's assertion that a child's death sought
Hodgman CH. The Suicidal Child. JAMA. 1987;257(12):1656. doi:10.1001/jama.1987.03390120118044