Purpose <p>Impedance telemetry objectively reflects the electrode–tissue interface and provides quantitative information on early postoperative impedance behavior after cochlear implantation. This study examined regional impedance shifts from surgery to early follow-up in paediatric recipients.</p> Methods <p>In a prospective cohort of 51 children (&lt; 14 years) implanted with identical 22-electrode arrays, intraoperative impedances were recorded and compared with 3-month postoperative values. Electrodes were grouped by region: basal (E1–E8), mid-turn (E9–E14), and apical segment (E15–E22), and analysed for median impedance changes by region, frequency, and persistence of anomalies, as well as inter-regional correlations.</p> Results <p>The most significant change occurred in the basal segment, where median impedance increased from 7.75 to 9.38 kΩ (<i>p</i> &lt; 0.0001), remained unchanged in the mid-turn (9.0 kΩ), and decreased slightly from 10.13 to 10.0 kΩ in the apical segment. Impedance shifts were strongly correlated across cochlear regions (rs = 0.65–0.91, <i>p</i> &lt; 0.001), except for a weaker association between the basal and apical segments (rs = 0.36, <i>p</i> &lt; 0.05). Among the 1,122 recorded electrode contacts, six displayed open- or short-circuit anomalies intraoperatively; most persisted at the same contacts, with one short circuit resolving and no new anomalies detected at 3 months.</p> Conclusion <p>Early postoperative impedance rises most prominently in basal segment contacts, consistent with expected early postoperative changes at the electrode–tissue interface, while mid-turn and apical segment contacts mostly remain stable or decline slightly. Ongoing impedance monitoring from implantation through early follow-up is vital for evaluating the electrode–tissue interface, optimising device programming, and identifying electrodes requiring deactivation or closer surveillance.</p>