Children with communication difficulties can benefit from augmentative alternative communication (AAC) aids to support them in daily interaction, as well as in developing milestones. One of the most difficult aspects of choosing a device is not only meeting the child’s current needs but also anticipating their developmental needs. This article provides an overview of the developmental milestones of typically developing children in the areas of communication, cognition, motor and sensory development, and compares this to that of children with Down Syndrome. The authors then highlight a number of specific AAC adaptations that could meet the needs of a child with Down Syndrome such as visual scene displays (e.g. photographs) that can be taken and added on the fly to meet the needs (and interests) of the child, and emphasise that issues such as positioning can enhance joint attention. Integrating toolbars and thumbnails on every page reduce the load on working memory, but can be enhanced or reduced as memory develops. Using larger symbols and integrating both low and high technology aids into daily use may support visual perception and allow and encourage children to develop ambulatory skills whilst also engaging in AAC use. The authors emphasise the need for further research to take both current and future developmental needs into consideration. Given the speed of development in the area of smart technology, there seem to be many simple solutions that can be imported into routine clinical practice around AAC, yet the current research evidence struggles to keep pace with these new developments that could open up new and exciting opportunities for children with communication needs. Further research collaborations between technology industry and communication disability experts is a priority.