Despite the advances in technology and sign language awareness, many Deaf and Hard of Hearing (DHH) children have language delays as a consequence of difficulty accessing a language model. These delays are often particularly pronounced in the domain of pragmatics, where the language user takes into account the people they are communicating with and their shared access to current context. This review considers the effect childhood deafness can have on pragmatic development, reviewing studies of the pre-linguistic stage, early linguistic communication and more advanced pragmatics as measured both by general pragmatic checklists and more specific assessments of information structure and inference, deception and non-literal language (including sarcasm), and conversation. Where present, delays are consistently explained by the cumulative effects of access to a fluent natural language model, which affects both the acquisition of linguistic forms and the social and cognitive skills needed to use them in interaction. Implications for educators are briefly considered.