Children with permanent hearing loss may communicate using either signed or spoken language individually, or in combination. The decision about which means of communication a child with permanent hearing loss will use is complex. To inform this process, a systematic literature review was conducted to determine the extent to which concurrent access to and use of spoken and signed language influences children's development of spoken or signed language skills commensurate with their non-verbal abilities. Searches of databases were conducted to locate studies published between January 1995 and November 2006. Four relevant studies were located but they were not designed to address the review's aim. Whilst a meta-narrative analysis indicated that children encouraged to concurrently develop spoken and signed language acquired both spoken and signed language, the relationships between these could not be isolated. Thus, it appears that there is little empirical evidence to inform this decision about which means of communication means to use. Consequently families need to consider their preferences along with professional expertise. Further, the unique needs of children acquiring signed and spoken communication systems concurrently need to be reflected in the service delivery models available.