As reported by the Centers for Disease Control and Prevention in 2015, a child aged 5 to 14 years dies by suicide nearly once per day in the United States. However, suicidality in children ages 10 and younger has not been researched separately from suicidality in adolescents and adults. Data in this qualitative grounded theory study were derived from a content analysis of 22 treatment charts of suicidal children age 10 and younger, as well as 12 semi-structured interviews with experienced treatment providers. Findings indicate that childhood suicidality involves a full range of expression (ideation, behavior, attempts, and even completions), several common precipitating conditions (i.e., abuse and neglect, separation from a primary caregiver, negative familial influences, and mental and physical illness), trends in the methods of self-injury, and a set of commonly related psychiatric diagnoses and conditions.