Although the literature suggests that multilingual augmentative and alternative communication (AAC) interventions hold benefits for children from multilingual backgrounds, there is little guidance on how such interventions can be implemented. While various barriers to this process have been noted, language ideology has not received much attention in the AAC literature. This paper aims to highlight multilingualism as both a linguistic and a sociopolitical phenomenon. An awareness of the influence of language ideology on AAC practice may lead to more considered and reflective approaches when supporting multilingual clients and their families. A description of the multilingual experience is followed by a discussion of language ideologies and views of multilingualism and how these may translate into AAC practices. Through a series of questions, AAC practitioners are encouraged to reflect on the influence of language ideology on their practices. The influence of language ideology on the legal and policy context, service models, and family language practices and choices is then explored. By situating AAC interventions for children from multilingual backgrounds within a macrosystemic and ideological framework, researchers and practitioners may be able to identify not just constraints on but also opportunities for providing person- and family-centered intervention.