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-old children with ECHS and 30 typically developing children. Children were compared on basic language measures and on proportions of symbolic and nonsymbolic talk. Children with ECHS focused on concrete “here-and-now” talk and produced less symbolic talk than normative 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 joint pretense and their overreliance on earlier acquired strategies for pretend play. This style of participation may result from difficulty coordinating more complex social intentions with appropriate language forms.