Engineering Changes (ECs) are a fact of life for companies in the Engineer-To-Order (ETO) production environment. Various Engineering Change Management (ECM) strategies, practices and tools exist, but no explicit distinction has been made regarding ECM in different production environments. Using a multiple case study method, this article investigates how ETO companies manage ECs and how ETO characteristics influence ECM. A generic ECM framework was developed and used to map ECM in the cases. The study showed that ETO companies use similar practices for handling ECs, while ECM tools are either not used by the companies or used to a very limited extent. It was found that the use of some ECM practices and tools is complicated by specific ETO company characteristics. However, no reasons were found for the lack of computerbased tools, change propagation and impact assessment tools, change reduction and front-loading tools, and design tools. This suggests, firstly, that there is vast room for improvement in ETO companies when it comes to ECM; and secondly, that the applicability of such tools should be further tested in the ETO environment. Based on the findings, some suggestions as to how ECM can be improved in ETO companies are given to practitioners.