Engaging children and caregivers in exposure and response-prevention (ERP) is a critical element in effective treatment of obsessive-compulsive disorder (OCD) in young children. Several clinical challenges pose barriers to participation and implementation of successful treatment such as specific parenting behaviors (e.g., accommodation of obsessions and compulsions) and child motivation for treatment. The authors offer strategies to address common clinical challenges in engaging young children with OCD and to promote effective implementation of ERP with children and caregivers.