This paper presents results of BC devices in very young children and helps inform an honest discussion of risks / benefit with prospective parents. The authors of this article from Starship Children’s Hospital, Auckland, New Zealand have a series of 24 children (26 ears) aged under five years who have had BAHA implantation. Most had two-stage surgery with a 3mm screw and skin thinning techniques, more recent patients had minimal or no soft tissue reduction surgery. Similarly three generations of implants were used as the series spans 11 years. A wide range of aetiologies were treated, typically isolated microtia. Benefit was assessed using a children’s version of the Glasgow Benefit Inventory with very high scores reported and a 75% response rate. Good hearing outcomes were also demonstrated with a Parents’ Evaluation of Aural perfomance of Children questionnaire. The authors have collected much detail on the complications encountered and present a comprehensive analysis: including a 42% return to theatre rate for skin problems, a 53% Holgers skin reaction grade three or worse and 10% implant loss. Despite these problems and the multiple repairs, only three children stopped using their implant suggesting significant benefit is gained and the audiologic benefits are clear. The benefit is clear but the complications may reinforce the argument for the use of semi-implantable or completely implantable devices for such children. It is a valuable addition to the BC device literature.