This review sought to determine the evidence base of augmentative and alternative communication (AAC) use with infants and toddlers with disabilities. The review identified 12 studies, involving 190 participants aged 36 months or younger. The majority of the studies investigated unaided AAC methods (e.g., gestures or sign language), with 42% of the studies also including aided AAC methods. Although all studies reported improvement in child communication following AAC intervention, in-depth analyses of study methodology indicated that only 7 out of 12 provided conclusive evidence. Implications for early intervention AAC practice and suggestions for future research are proposed.