The implantation of young children is widely accepted as a means of rehabilitating profoundly/totally deaf children. This paper will review the surgical aspects of implanting young children based on the first 50 children implanted in the Nottingham paediatric cochlear implant programme. Having thoroughly counselled the children's parents, the child is operated on under prophylactic antibiotic cover. The incision (extended endaural) is made directly down to bone and a full-thickness flap is elevated. Meticulous attention is paid to haemostasis. The steps involved in posterior tympanotomy, cochleostomy and implant insertion, often in the presence of osteogenesis, will be described. Electrophysiological testing is done systematically peroperatively. Surgical complications were few. There was no cases of facial weakness, haematoma, implant extrusion or infection. One patient, whose implant was laid in an extracochlear gutter, developed pain on electrical stimulation and was explanted. Another patient developed a retraction pocket cholesteatoma. These few complications are far outweighed by the overwhelming benefits accrued from implantation.