We are in a youth mental health crisis that includes unprecedented and staggeringly high rates of suicidal ideation and behaviors in preteens. Because the majority of children and preteens attend well-child primary care visits, equipping pediatricians with brief and effective suicide screening and assessment skills is a priority for youth suicide prevention and management. Current clinical practice guidelines focus on adolescent and young adult populations, leaving pediatric practitioners without vital tools to detect and prevent suicide in younger populations. The objective of this project was to develop evidence-informed suicide risk screening pathways for pediatric practitioners to implement with school-age and preadolescent patients (ages 5-12). We convened a group of researchers and practitioners with expertise in preadolescent suicide, pediatric medicine, behavioral health screening integration with primary care, and child development. They reviewed the empirical literature and existing practice guidelines to iterate on a clinical screening pathway. As a result, we provide tools that help determine risk level, suicide screening and assessment workflow, and resource contacts, which are evidence-informed guides for suicide detection and prevention in children aged 5-12. Scripts for introducing the suicide screening and assessment to parents and children and how to discuss findings from screening are included in an appendix. Future research should refine and improve ways to manage preteen suicide risk in primary care settings.