Objectives: The suicide rate for 10- to 14-year-old children in the U.S. nearly doubled between 2007 and 2017, making suicide the second leading cause of death for this age group. Clinically indicated suicide risk screening can provide a crucial entry point into suicide prevention care pathways. Preliminary examinations of recent trends in suicide risk screening in the Nationwide Children’s Hospital (NCH) system indicate substantial increases in rates with which preteens are presenting with suicide risk. Methods: NCH created a clinical care pathway for suicidal youth, which includes risk screening tools embedded in an electronic health record. This “Suicide Risk Toolkit” includes a screener (i.e., Ask-Suicide Questions [ASQ; Horowitz et al., 2012]; and assessment (Columbia-Suicide Severity Rating Scale [C-SSRS; Posner et al., 2008]), as well as a checklist of risk and protective factors to aid clinicians in the identification and management of suicide risk. The toolkit is used throughout NCH Behavioral Health (NCH-BH). For this proposal, we focus on two areas: Psychiatric Crisis Department (PCD) and the Outpatient Crisis Clinic (OCC). Results: We examined trends in rates at which preteens are screened for suicide risk in our PCD and rates at which they screen positive for suicide risk on the ASQ (i.e., respond “yes” to at least one item). Between 2020 and 2022, the number of 8-9-year-olds screened for suicide risk increased from 147 to 267 (81% increase), and the percent of 8-9-year-olds who screened positive for suicide risk increased from 61.9% to 66.7%. The rates at which children present to the OCC, which has lethality concerns as an inclusion criterion, have increased for all ages between 4 and 10 (2023 vs. 2019-2022), with specific percent increases ranging from 7-414%. We will expand upon these analyses by examining a large dataset derived from our screening toolkit for children aged 4-12 across NCH-BH. Analyses will focus on the number of children in this age group who are screened across settings, the number who screen positive, and the number with current active suicidal ideation. Conclusions: Preliminary analyses of preteen suicide risk screening trends indicate that rates at which preteens present across emergency and outpatient crisis clinical settings are increasing, as is the rate at which they are identified as having recent or current suicide risk when screened. Additional analyses will clarify the scope and scale of these trends.