The development of narrative content was studied in 100 children aged 6-15 years (49 with early-onset hydrocephalus and 51 age-matched controls) by analyzing transcripts of oral texts produced from their narrations of two fairy tales. In relation to those of their age-matched peers, the narratives of the children with hydrocephalus were less cohesive and less coherent. They conveyed less of the content needed for the narrative message, included more referentially ambiguous material, included uninterpretable or implausible content, and were more verbose and less economic in quality. In relation to their age-matched peers, then, children with hydrocephalus produce narratives that are difficult to process, unclear, uneconomic, and less fully elaborated for meaning. These data add to an emerging body of information that shows children and adolescents with early-onset hydrocephalus to be at risk for several types of discourse and pragmatic impairments. The language of children with hydrocephalus is discussed with reference to the theoretical distinction between interpersonal pragmatic conventions and constraints relating to textual rhetoric (processability, clarity, economy, and expressivity). By showing impaired textual rhetoric coexisting with apparently preserved interpersonal rhetoric in individuals with developmental anomalies of brain development, the present data provide some support for a functional dissociation between the two classes of pragmatic constraints.