We present modifications of the technique of harvesting adult tibial cancellous bone that enables its safe and reliable use in children. We studied 15 children undergoing secondary grafting of alveolar clefts radiographically and clinically and compared them with a similar group of children who had bone harvested from the iliac crest. Duration of hospital stay (mean 1, range 1-2 compared with 3, range 2-4) analgesic requirements (duration 1-4 days compared with 1-3 weeks) were all considerably less when bone was taken from the proximal tibia and mobility was considerably improved table to walk on day 1 compared with restricted walking for 1-3 weeks.