Research has shown how cochlear implants (CIs), in children with hearing impairments, have improved speech perception and production, but very little is known about the children's pragmatic language development. During a 4-year longitudinal study of three children with CIs, certain aspects of pragmatic language development were observed in free social peer interaction. Observations were analysed both quantitatively and qualitatively. Some of the analysed aspects were speech intelligibility, auditory performance, turn-taking, response, repair, and gaze behaviour. The three children improved their speech intelligibility and auditory performance during the 4 years, but they continued to have difficulties with pragmatic language usage. Included in this study are explanations of pragmatic language difficulties among some children with CIs and other related issues as peer interaction, theory of mind, psychosocial wellbeing, and self-efficacy. Some children with CIs may face pragmatic language difficulties; therefore, supporting a child's pragmatic language development could be conducive to their social and linguistic development. (Contains 2 tables.)