Only 15% of children with hearing loss who could receive a cochlear implant receive one leaving American Sign Language (ASL) as their access to communication. Spanish-speaking families face even greater challenges including learning different languages/cultures and lack of trained Hispanic professionals. This study identifies how Hispanic mothers communicate with their children with hearing loss who use ASL as their primary language. Data for this qualitative study were collected using in-depth, open-ended ethnographic interviews and limited participant observations and analyzed using grounded theory. Results indicated that many mothers did not learn ASL or learned it some years after the diagnosis of hearing loss in their child; therefore, many children had no or limited language early on and were excluded from conversations and activities. Often mothers learned ASL in Spanish resulting in communication that varied in grammar. Language confusion can result in children's lower overall language skills and poor academic achievement.