Obsessive-compulsive disorder (OCD) was initially considered an adult disorder, and its recognition in children did not occur until the mid-twentieth century. OCD affects between 1% and 3% of children and adolescents and can cause severe impairment if left untreated. Obsessions are recurring, persistent thoughts, urges, or images that intrude upon an individual’s mind and are perceived as unwanted and distressing. Conversely, compulsions are repetitive behaviors that the individual feels compelled to perform, often in response to an obsession. These actions provide temporary relief from the anxiety or discomfort triggered by the obsessions. Symptoms of OCD vary considerably between individuals, but common themes for obsessions and/or compulsions include contamination fears, fear of harm, and the need for symmetry and ordering. Comorbidity is common in OCD, with most patients having at least one other psychiatric disorder. A thorough assessment of pediatric OCD is essential for understanding the symptoms and selecting the right treatment strategy. This detailed evaluation should cover past and present symptoms, the impact on functioning, family responses to the condition, the child’s awareness of their symptoms, and any coexisting mental health issues. Cognitive-behavioral therapy (CBT) is the recommended first line of treatment for OCD, but selective serotonin reuptake inhibitors (SSRIs) are recommended if CBT outcomes are not sufficiently effective. Although treatment is effective for most children and adolescents with OCD, new treatment options are needed for those who do not benefit from currently available options. Additionally, high priority should be given to making CBT for OCD more readily available to children and adolescents.