Pediatric OCD adapts exposure and response prevention (ERP) to growing brains, busy families, and real schools. pediatric OCD conference Start with a careful differential and functional map: tics, ASD traits, ADHD, anxiety disorders, PANS/PANDAS considerations; daily impacts on morning routines, class attention, friendships, mealtimes, and bedtime. Explain OCD in child-friendly language—“a bossy alarm system that makes false threats”—and build hope by linking treatment to values kids recognize (play, curiosity, kindness, competence). ERP is the centerpiece, but it has to be bite-sized and frequent: two to five short practices per day, tracked with stickers or points, with caregivers coaching “brave practice” instead of providing reassurance or participating in rituals. Hierarchies are specific and observable (touching the doorknob without washing for five minutes; writing a feared word and waiting) and expand as mastery grows. Sleep and circadian anchors matter: consistent wake time, morning light before school, wind-down routines that cut late-evening reassurance loops. SSRIs can augment ERP when impairment is high or progress stalls; dosing is low-and-slow with side-effect check-ins and plain-language handouts. School is a treatment partner: brief teacher scripts, bathroom plans, and 504/IEP accommodations protect learning while exposures occur in natural settings (locker, lunchroom, gym). Tele-school exposures and home visits extend reach; interpreters and low-literacy visuals reduce barriers; transport and scheduling supports prevent drop-offs for working families. Equity also means addressing stigma directly and inviting peers (when appropriate) to celebrate effort, not perfection. Measure what kids and parents care about: exposures completed, time reclaimed from rituals, school participation, play and friendships, sleep quality—not just CY-BOCS scores. When progress slows, check hierarchy granularity, sleep timing, family accommodation, and medication fit before adding complexity. Recovery is not the absence of intrusive thoughts; it is a growing ability to choose, to play, to learn, and to be present with the people who matter.