OBJECTIVE This study was conducted to examine whether pediatric patients with obsessive-compulsive disorder (OCD) and hoarding symptoms differed in terms of clinical characteristics from pediatric OCD patients without hoarding symptoms. METHOD Eighty children and adolescents with OCD (range, 7-17 years) completed clinician-administered and parent- and child-report measures of OCD symptom severity, impairment, and emotional and behavioral symptoms. RESULTS Twenty-one youth endorsed significant hoarding symptoms. Relative to nonhoarders, youth with hoarding symptoms had worse insight, more magical thinking obsessions, and ordering/arranging compulsions than nonhoarders, higher levels of anxiety, aggression, somatic complaints, and overall externalizing and internalizing symptoms. Higher rates of panic disorder were found in youth with hoarding symptoms although other comorbidity rates did not differ. CONCLUSIONS These findings in children are partially consistent with studies in adults, and suggest that pediatric patients with hoarding symptoms may exhibit a unique clinical presentation.