Children with histories of early corrective heart surgery (ECHS) are at risk for language,cognitive, and motor delays. This study examined parent–child play in 30 4-year-oldchildren with ECHS and 30 typically developing children. Children were compared on basiclanguage measures and on proportions of symbolic and nonsymbolic talk. Children with ECHSfocused on concrete “here-and-now” talk and produced less symbolic talk thannormative children. Only a third of the children with ECHS were able to produce story episodes.These findings reflect the ECHS children's relatively immature participation in jointpretense and their overreliance on earlier acquired strategies for pretend play. This style ofparticipation may result from difficulty coordinating more complex social intentions withappropriate language forms.