Charlie never spoke, was unable to walk, and could not feed herself, yet she communicated and expressed her full range of emotions (most of all, joy) to all she encountered. In this article, we share our journey in the health care system advocating for providers to communicate with our daughter, Charlie, who did not communicate with words. INTRODUCTION (DRS SCHNAITH AND PITT)Effective clinician-patient communication is linked to better health outcomes and patient satisfaction. 1,2 Accordingly, there is a growing emphasis on clinicians recognizing that how both what we say and how we say it affects our patients' health and well-being. These efforts tend to focus on modifying the language we use (ie, recognizing how often we inadvertently use jargon 3 ) or learning ways to demonstrate empathy so our patients feel heard. 4 Although these skills are essential, they inherently rely on the presupposition that our patients themselves communicate verbally. In pediatrics, however, a core demographic of our patients have yet to develop this ability. Additionally, we often care for children with complex medical needs who may never communicate verbally. As pediatricians, we must expand our communication skillset. Failing to consider nuances in communicating with families of children who do not communicate with words (and with the children themselves) sets us up for predictable challenges. 5