Purpose of Review <p> This review examines pediatric obsessive-compulsive disorder (OCD) and recommendations for telehealth exposure and response prevention (ERP). Literature is summarized along with clinical expertise to provide clinicians with suggestions to optimize pediatric OCD treatment. </p> Recent Findings <p> Over the past five years, telehealth ERP has become common. Comparable treatment outcomes to in-person services and greater access to care suggest this telehealth ERP is likely to stay. While ERP is conceptually unchanged by telehealth, significant differences compared to in-person ERP exist that require clinicians, children, and their caregivers to make relevant modifications and treatment decisions. Domains reviewed in this piece include assessment, diagnostic feedback and psychoeducation, rapport building and treatment motivation, in-session exposure practice, and considerations for hybrid models.</p> Summary <p> In-person and telehealth delivered ERP are not interchangeable, and clinical expertise paired with family preferences must be considered when determining which modality is optimal for treating childhood OCD.</p>