Key Points Question Did trends and seasonal patterns of suicidality among children and adolescents change after the onset of the COVID-19 pandemic in March 2020? Findings This cross-sectional study of 73 123 emergency department (ED) visits and hospitalizations for suicidality found that the incidence of ED visits and hospitalizations increased from 2016 to 2021, with a temporary decline in 2020. Prior to the pandemic, monthly incidences were typically higher during the school year, but during the spring of 2020, coinciding with school closures, they were substantially lower. Meaning This study’s findings suggest that the unexpected decrease in suicidality among children and adolescents after school closures supports hypotheses that suicidality is associated with the US school calendar.