&NA;Components important for achieving preverbal communicative competence in children who are developing typically are described to understand their significance as they relate to children with severe physical impairment (SPI). Specifically, eye gaze, attention, and gesture are described as they relate to reciprocity, consistency, and predictability of infant‐caregiver interactions. Because of a limited number of studies related to children with SPI, inferences are drawn from research with children who are developing typically. These inferences are used to suggest intervention strategies that could be used by practitioners and caregivers to facilitate optimal communication and cognitive growth for infants with SPI.