We retrospectively analysed all cases of iliac crest bone graft harvest for secondary grafting of the cleft alveolus during an 11-year period. The case notes were reviewed and postal questionnaires sent to all patients. Of 73 consecutive patients, 57 (78%) were male, and the mean (S.D.) age at operation was 10 (1) years. A completed questionnaire was received from 72 patients (99%). The median stay in hospital was 3 days (range 2-5). The median time until the child could walk "normally" was 7 days (range 0-56). Thirty-seven patients (51%) had a postoperative limp, which resolved after a median of 7 days (range 3-56). There were two (3%) superficial donor site infections. The median length of scar was 60mm (range 40-100) and patient satisfaction was high, with a median visual analogue scale of 9/10 (range 2-10). Harvesting bone from the iliac crest for alveolar bone grafting is well tolerated by patients, has few important complications, and gives an aesthetically acceptable scar at the donor site.