Pediatric obsessive-compulsive disorder (OCD) is characterized by intrusive obsessions and compulsive rituals that significantly interfere with daily functioning. Cognitive-behavioral therapy (CBT), specifically exposure and response prevention (ERP), is the gold-standard treatment for pediatric OCD. This chapter provides an overview of the cognitive-behavioral model of OCD, highlighting the role of avoidance and compulsive rituals in maintaining symptoms. We discuss the implementation of ERP, including functional assessment, psychoeducation, exposure hierarchy development, and response prevention strategies. Additionally, we explore the importance of parental involvement, given the impact of symptom accommodation on treatment outcomes. Finally, we examine common barriers to treatment, strategies to enhance engagement, and emerging therapeutic augmentations such as acceptance and commitment therapy (ACT). By emphasizing evidence-based interventions and family-based strategies, this chapter aims to provide clinicians with a comprehensive guide to optimizing treatment outcomes for children with OCD.