The management of adolescent suicidal behavior in the practices of 48 pediatricians from Rochester and Syracuse, New York, was reviewed in the context of a rising local and national incidence. Alternative resources were found to be used much more heavily by suicidal adolescents in the two communities. Few pediatricians ask routinely about suicidal thoughts. The fatality rate is low enough to reinforce present practice, but suicidal symptoms are far more frequent than fatalities. It is hypothesized that avoidance of the issue by the pediatrician results in underutilization of this potentially valuable resource. Asking about the problem may result in a higher contact rate and, it is proposed, a better outcome. Depressive symptoms and appropriate responses to suicidal thinking are discussed.