Background Clinicians increasingly work with multilingual paediatric clients across healthcare and community settings. Collecting detailed language background is a crucial first step in planning effective assessment and intervention. Yet, little is known about how this process unfolds in everyday public-sector clinical practice. To improve service quality, equity, and effectiveness for multilingual children, this study investigates how clinicians gather, interpret, and use language history information: as well, it examines the institutional and professional barriers and facilitators that shape this aspect of clinical practice. Methods A qualitative study was conducted using semi-structured interviews with 21 clinicians working in public-sector and community-based settings across Canada. Data was analysed using framework analysis, guided by the Theoretical Domains Framework. Results Clinicians universally recognized the value of language history and routinely embedded it within the broader case history. However, variability emerged in what information was gathered, how it was elicited, and how it was used. Practices were shaped by clinician experience, institutional processes, documentation systems, and availability of training and tools. Many relied on flexible, conversational strategies over research-developed tools, often constructing their own frameworks in response to contextual demands. This adaptability reflected the development of adaptive expertise but also risked inconsistencies in data quality, especially in the absence of formal guidance, structured tools, or interpreter support. Conclusion Language history collection is a complex, multidimensional task influenced by clinician initiative and systemic constraints. Strengthening practice will require hybrid tools that balance structure with flexibility, clearer protocols across disciplines, and institutional investments in interpreter services, training, and culturally informed workflows. Keywords: bilingualism, language history, speech-language pathology, public-sector clinicians, qualitative research 

The authors have declared no competing interest.

This work was supported by the Natural Sciences and Engineering Research Council of Canada (RGPIN-2019-06523); Hilda and William Courtney Clayton Paediatric Research Fund; Peterborough K. M. Hunter Charitable Foundation Graduate Award.

I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.

Yes

The details of the IRB/oversight body that provided approval or exemption for the research described are given below:

The Ethics committee/IRB of the University of Toronto gave ethical approval for this work.

I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.

Yes

I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).

Yes

I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable.

Yes

Due to the qualitative nature of this research and to protect participant confidentiality, the interview transcripts and related data are not publicly available. Supplementary materials related to the study are available at the borealis repository.

https://borealisdata.ca/dataverse/languagehistory/