OBJECTIVE: To assess the audiometric and surgical outcomes of implanted Osia® 2 bone conduction devices in a large paediatric population. METHODS: We conducted a retrospective electronic patient record review of patients implanted with the Cochlear™ Osia® 2 system, over a two-year period. Pre-operative clinical details, audiometric data, operative details and post-operative surgical and audiological outcomes were recorded. RESULTS: 66 Osia® 2 devices were implanted in 49 patients between September 2021 and September 2023 (median age: 9, range: 5-18). Patients were followed up in the ENT clinic for an average of 8.7 months. The majority of cases were primary surgery with patients using a BCHD on softband prior to surgery. Post-op pure tone audiometry and speech in noise testing showed a notable improvement post Osia (vs aided pre Osia) which was significant at 4 KHz and 0 dB speech-noise-ratio. There was one case of infection requiring explant and re-implantation with no further issues. Other post-operative complications included abnormal scarring and neuropathic pain. Subjective reports from the device users reflected high daily compliance and overall satisfaction with the device. CONCLUSION: The Cochlear™ Osia® 2 is a relatively new active, transcutaneous osseointegrated implant, which has been available to our paediatric practice since September 2021. Our experience demonstrates the device is an increasingly popular choice amongst paediatric patients and can be safely implanted in children. We advocate simultaneous bilateral implantation in children with bilateral hearing loss. We have seen limited surgical complications and overall excellent audiometric outcomes.