Cochlear implant (CI) is a well-established treatment for children with sensorineural hearing loss without benefit from hearing aids. The Italian guidelines date back 15 years; given the expansion of indications for CI (including single side deafness and asymmetrical hearing loss) it became necessary to establish updated guidelines.Thirteen experts and 2 patient representatives selected the key questions and drew up recommendations. The document was developed following the GRADE methodology. The methodological team of the Mario Negri Pharmacological Research Institute performed systematic reviews for each question and supported the overall process.Four key questions were identified and recommendation formulated, with subgroups and implementation considerations.Though the systematic research of scientific literature found a scarcity of randomised trials and an overall poor conduct and reporting quality of primary studies and systematic reviews, conditional recommendations in favour of CI have been formulated for different subgroups of children. Further studies should enrol a larger number of participants and use consistent instruments to evaluate hearing outcomes, in order to increase comparability of results and data pooling through meta-analysis.