Purpose: The identification of child, device, and family/environmental factors that are associated with optimum language outcomes for infants and children using cochlear implants is a high research priority. Understanding the contributions of these factors for an individual child and family may inform clinical decisions about intensity of services and choice of intervention. Clinicians, using family-centered principles, must use available evidence to improve the pre-implant expectation counseling that we provide to parents. Outline: This paper summarizes a series of studies that have examined outcomes for current cohorts of children using cochlear implants. There is an overview of studies that have followed the children to school age, to 9 years of age, and into adolescence and adulthood. More details are provided for two long-term studies: one prospective and one retrospective. The prospective study recruited 25 children to complete standardized tests of reading, phonological processing, and spontaneous writing at age 11 to 19 years. The retrospective study examined existing language data for children who received their first cochlear implant before 3.50 years to derive 460 receptive and 252 expressive language trajectories. Results: Numerous studies have demonstrated evidence that age-at-implant younger than 12 months is associated with better language outcomes. There is emerging evidence that age-at-implant younger than 9 months is associated with better long-term language outcomes. Discussion/Conclusions: These studies are discussed with reference to potential barriers and facilitators to early implant using Atkin's and colleagues (2017) Implementation Science standpoint. Over the last 30 years of pediatric cochlear implants, we have learned to consider the diversity of children who are deaf and hard of hearing (DHH) and consider how best to deliver early intervention. Second, we have learned that the simple tests of speech perception, production, and language (we started with 30 years ago) need to be complemented by measures of quality of life, identity, and happiness. Third, we have learned that the term 'long-term studies' does not mean 'to school age' or 'to adolescence', but must be extended to adulthood.