This study explored the decision-making processes of medical examiners in the determination of child suicide. Ninety-four medical examiners completed a survey regarding those factors considered when making a child suicide determination, sources of information used, and considerations in accident vs. suicide classifications. No significant differences between groups of respondents were observed. Well-known risk factors such as suicide notes were considered by virtually all participants, but other risk factors (e.g., substance abuse) were not consistently taken into consideration. Common sources of information included informant interviews and review of records. Results indicate that age and evidence of intent are critical considerations in this process. Implications in terms of misclassification and prevention efforts are discussed.