The use of sign and the emergence of speech skills by children who are deaf and use a cochlear implant were examined. Twenty-five children who had an average of 43 months of experience with a Nucleus cochlear implant and who are educated in a simultaneous communication environment engaged in spontaneous conversation and completed speech production and audiological tests. During spontaneous conversation, the children used voice and sign to express whole words in their conversations 70% of the time, voice only 21%, and sign only 9% of the time, suggesting that use of a cochlear implant does not result in elimination of signing. Children demonstrated a wide range of intelligibility. Pearson correlations indicated that children who had better intelligibility were most likely to use voice only, while children who had poor intelligibility were most likely to use sign only. Analysis of the children's consonant production over time suggested that fricative production emerges relatively early; but follows emergence of other speech skills, including the ability to produce nasal consonants. Measures of consonant production were significantly correlated with measures of consonant perception. This suggests a close link between children's ability to produce speech and perceive speech.