INTRODUCTION: Hydrocephalus remains a common neurosurgical problem in the pediatric population. Despite the advent of newer interventions such as third ventriculostomy, ventriculoperitoneal shunting remains a mainstay of therapy. Because of the unique anatomy of the infant cranium (e.g., open cranial sutures), overshunting complications such as overriding parietal bones and microcephaly may be encountered with the use of fixed-pressure valves. We describe the use of programmable valves in infants requiring ventricular cerebrospinal fluid (CSF) drainage to prevent overshunting complications. METHODS: We retrospectively examined 22 patients who underwent placement of a programmable ventriculoperitoneal shunting device during the perinatal period for treatment of hydrocephalus at the University of California, San Francisco Medical Center. Mean follow-up period was 1.5 years. Valves were set at low pressures (30 mm Hg) at insertion. Pressure settings were increased to 150 mm Hg at the 1-month interval. Head circumference measurements were taken at presentation, at surgery, and at 1-, 3-, 6-, and 12-month intervals. Data were analyzed for number of subsequent valve adjustments, number of revisions, and incidence of all complications. RESULTS: All patients underwent successful placement of a programmable ventriculoperitoneal shunting device. Two patients underwent removal and replacement of the device secondary to infection. Seven patients underwent revision secondary to malfunction. Mean head circumference measurements remained between the 50th and 90th percentiles for age throughout the follow-up period. CONCLUSION: The reported incidence of CSF overdrainage secondary to ventriculoperitoneal shunting varies between 5 and 55%. These potential complications include intracranial hypotension, low-pressure syndromes, slit ventricle syndrome, intracranial hemorrhage, cranial deformities, and microcephaly. No overshunting complications were observed in this study population. We conclude that the advent of programmable valves may provide neurosurgeons with an additional tool in preventing complications of overshunting in infants with hydrocephalus.