The purpose of this article is to explore recommended practices in choosing and using key word signs (i.e., simple single-word gestures for communication) to facilitate first spoken words in hearing children with language delays. Developmental, theoretical, and empirical supports for this practice are discussed. Practical recommendations for choosing first word–sign pairs from both functional communication and developmental lexical perspectives are provided. A critical reflection of existing word–sign recommendations is undertaken to sharpen clinical decision-making skills. Implementation strategies from language and sign intervention literature are included with examples.