Brain imaging studies suggest that children can simultaneously develop, learn, and use two languages. A visual language, such as American Sign Language (ASL), facilitates development at the earliest possible moments in a child's life. Spoken language development can be delayed due to diagnostic evaluations, device fittings, and auditory skill development. While the auditory pieces are coming together, visual language should be used to support a child's cognitive development and social-emotional well-being. Once auditory access is established and auditory skills are developing, the two languages can be used to support education and bilingual approaches are available as teaching tools. New auditory technologies--from cochlear implants, to hearing aids, to devices that allow sound to be carried to the brain through bone conduction--provide many deaf and hard of hearing children with improved access to spoken language. These devices have become increasingly sophisticated; more deaf and hard of hearing children than ever before access spoken language so extensively they can learn through listening. This article discusses hearing aids, cochlear implants, and the need for teachers and professionals to continually monitor and tailor teaching as a child develops in bilingual programs that equally respect ASL and spoken English and facilitate development of both languages.