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A survey of child amputee clinics in North America explored early fitting of children with unilateral below-elbow limb absence. Responses from 45 of 80 (56%) clinics revealed that most clinics prefer to fit at 6 months and add an active control system by 18 months. These are earlier ages than had been reported in the literature. Myoelectric hands with single site controls are often applied before 1 year. Responders indicated that child development guides the timing for initial fitting and the change to an active terminal device. Independent sitting is the most-used indicator for first fitting; awareness of cause and effect indicates readiness for activation. Passive hands are most often fitted initially. Approximately equal numbers of clinics prefer to use voluntary opening and voluntary closing terminal devices in the active fitting. Myoelectric hands are increasingly used. No significant differences were found between timing and terminal device preferences among clinics in various regions of the US and Canada and between Shriners and non-Shriners Hospitals. Financial considerations were not important in selecting the terminal device except in one-third of clinics at the time of activation. Parents are doing more of the training than was reported in the past, and few clinics use objective tests to measure outcomes of fitting. Responders identified many features they would like to include in a child’s new terminal device.