Youth suicide remains a leading cause of death in the United States and is especially pronounced in populations that have been historically underserved. Multipronged public health strategies aimed at addressing suicide may be particularly effective in pediatric medical settings, as most youth who die by suicide have visited a health care provider prior to their death. The finding that most youth suicide decedents have no mental illness diagnosis further underscores the importance of screening. This review highlights universal screening as a strategy to improve detection and management of at-risk youth. We present current research on evidence-based screening tools, clinical pathways to support the feasibility and fidelity of screening, brief interventions for managing positive screens, issues regarding screening and health equity, considerations for diverse populations, current innovations, and future directions for research and clinical practice. Evidence supports universal suicide risk screening through feasible clinical pathways that leverage pediatric health care providers as partners in suicide prevention.