The field of osseointegrated bone-conduction hearing devices continues to change rapidly. In just the last few years several new devices have emerged onto the market and established devices have had major changes in functionality and usage. This is especially relevant for children as factors ranging from calvarial thickness to FDA guidelines can have a major impact on which device is right for what patient. This expert lecture will present the audience with an up-to-the minute synopsis of implanted bone conduction hearing device technology for children to inform patient counseling and surgical decision making. Topics will include the relative advantages and disadvantages of percutaneous, transcutaneous, piezoelectric, and floating-mass transducer-based bone conduction systems in terms of performance and surgical technique. A detailed summary of the indications, features, and imaging guidelines for the devices of all major manufacturers will be presented. Current FDA indications and guidelines will be discussed.