Pediatric ossiculoplasty presents the surgeon with a number of unique challenges relating, for example, to timing, choice of graft material, stabilization, and reconstruction. The aim of the current article is to review 10 important considerations in pediatric ossiculoplasty in an effort to maximize outcomes while minimizing complications. Routinely and systematically addressing each of these factors prior to and during ossiculoplasty in every pediatric patient will both optimize and contribute to understanding the hearing results achieved.