Suicide is the third leading cause of death for youths aged 15 to 24 years in the United States. Approximately 2 million US adolescents attempt suicide each year, and 19% report serious consideration of suicide in the past year. Although suicidal adolescents are frequently treated in emergency departments (EDs), there are few publications about their ED management. Therefore, we reviewed the literature for recommendations for the management of adolescents with suicidal ideation or attempts. Hospitalization is recommended for adolescents who have attempted suicide and cannot be adequately monitored and kept safe outside of an inpatient setting. Discharge home can be considered for a subset of adolescents with suicidal thoughts if urgent follow-up mental health care can be ensured and responsible caregivers can adequately supervise and protect the youth. This subset includes adolescents who are not actively suicidal, do not have access to lethal methods, and have a supervising adult who can closely monitor their behavior. A mental health evaluation is recommended before ED discharge whenever feasible.