Purpose: The purpose of this study was to examine the extent to which phonological competition and semantic priming influence lexical access in school-aged children with cochlear implants (CIs) and children with normal acoustic hearing. Method: Participants included children who were 5-10 years of age with either normal hearing (n = 41) or bilateral severe to profound sensorineural hearing loss and used CIs (n = 13). All participants completed a two-alternative forced-choice task while eye gaze to visual images was recorded and quantified during a word recognition task. In this task, the target image was juxtaposed with a competitor image that was either a phonological onset competitor (i.e., shared the same initial consonant-vowel-consonant syllable as the target) or an unrelated distractor. Half of the trials were preceded by an image prime that was semantically related to the target image. Results: Children with CIs showed evidence of phonological competition during real-time processing of speech. This effect, however, was less and occurred later in the time course of speech processing than what was observed in children with normal hearing. The presence of a semantically related visual prime reduced the effects of phonological competition in both groups of children but to a greater degree in children with CIs. Conclusions: Children with CIs were able to process single words similarly to their counterparts with normal hearing. However, children with CIs appeared to have increased reliance on surrounding semantic information compared to their normal-hearing counterparts.