The current study explored literacy interest or orientation of pre-school children with hearing impairment during mother-child story book interactions. Twelve pre-schoolers with varying types and levels of hearing impairment were observed during mother-child home book reading and toy play. Story books included both narrative and manipulative book genres. Child orientation to the task was qualitatively rated with a four-point Orientation Rating to Book Reading/Toy Play; mothers' modification of the book's text was scored with the Modification of the Book's Text Rating. Results indicated that: (1) children should have more than one opportunity to explore and interact with a book before orientation is assessed, (2) children demonstrated a higher mean level of orientation to manipulative books versus narrative books across the three interactions, and (3) modification was negatively correlated with children's age (i.e. the text was more likely to be read verbatim with younger children). (Contains 4 tables.)