Research has shown that cochlear implants have become a popular option for many families who have young children with severe-to-profound hearing loss. Findings show that while improvements in spoken language outcomes for children and young people who use cochlear implants are evident, there are large individual differences in performance. Studies that investigate spoken language outcomes for children with hearing loss typically report results based on measures of receptive and/or expressive language or in the subsystems of syntax, semantics, morphology or phonology. There is less research that focuses on the social use of language, that is, the specific pragmatic skills that are challenging for children and young people with hearing loss. Further research is needed to detail the context in which children develop pragmatic competencies in order to inform clinical practice.This chapter provides an overview of studies of pragmatic development in children who have cochlear implants. It is illustrated throughout with data from our own research. We detail the CONVERSATION model of intervention (adapted from Paatsch and Toe 2016) as a framework for highlighting current research and informing clinical practice. The aim is to demonstrate how research and practice can support pragmatic development in children with hearing loss.