The number of pediatric cochlear implants (CI) has markedly increased in Japan from 1998. However, when we recommend pediatric CI for use, several points should be taken in consideration, such as the age of indication, improvements in the device and the establishment of a rehabilitation system. In regard to the age for indication, recent reports highly recommend early implantation at less than 2 years of age. In regard to improvements in the device that are now taking place for both the hard and soft parts, the miniaturizing of implantable parts and speech processor might produce a fully implantable CI in the near future. The development of neural response telemetry has the potential for automatic mapping in pediatric patients who respond less to oral stimulation. A suitable rehabilitation system after CI is yet to be fully established in Japan and local centers for CI, possibly including deaf schools for mapping and rehabilitation, are urgently needed. It is possible that children with profound hearing loss can come into the main stream of education with the wide spread promotion and use of CI.