This conversation analysis study investigates facilitators’ simultaneous use of speech and aided means in instructional interaction with children with complex communication needs (CCN), who use aided communication in an everyday setting. The participants were children with severe speech impairments and their everyday communication partners. The analysis focused on facilitators’ aided turns immediately following aided turns by the children, within so-called retro-sequences. Retro-sequences were found in interactions involving four out of nine children. The facilitators systematically combined a spoken turn with an aided turn, a speaking and pointing (SAP) practice. The pointing consisted of a single graphical word, mostly a noun. The multimodal practice generally highlighted, emphasized, or exposed graphical words that increased noticeability and understandability within the local context. Adult repeats were treated as requests for confirmation of a candidate understanding and were responded to by the child using vocal and embodied resources. Reformulations (recasts) were treated as profferings of candidate understandings and were responded to using the communication device. The findings indicate that the partner’s use of a spoken and aided follow-up action shaped the immediate context for device use. The findings are relevant for the design of naturalistic interventions and may be used to improve treatment descriptions in augmentative and alternative communication (AAC) interventions.