The preceding article by Hawton and colleagues reporting on a prospective study of adolescents presenting with self-harm to Accident and Emergency departments (A&E) is one of the largest epidemiological studies to examine the long-term outcomes of self-harm in children and adolescents. After a median of 6 years nearly 30% re-presented to A&E with self-harm and 1% died, half of those due to likely suicide and the rest mainly due to accidents. It may be that many accidental deaths were also suicides judging from the method of death. In comparison to adults presenting with self-harm, the absolute risk of suicide was lower despite a high self-harm repetition rate. Self-injury by cutting was a strong independent predictor of suicide as was previous psychiatric treatment and previous self-harm. Finally the eventual method of suicide was different from that used at either the first or the last episode of self-harm. This is at odds with the data generated by adult literature which consistently shows that those with the most violent methods of self-harm, e.g. attempted hanging or shooting, tend to also die using these methods. In summary the field of adolescent self-harm is of immense importance and requires urgent research to develop our ability to predict those likely to die of suicide, and to offer effective treatment to those at risk. The article by Hawton and colleagues is an important step in our understanding of the risk factors of suicide in those adolescents who present with self-harm and in highlighting the overlapping nature of self-injury and self-poisoning in relation to suicide.