Anxiety disorders are among the most prevalent pediatric behavioral health conditions, affecting roughly 32% of youths prior to adulthood, and associated with impaired functioning that can continue into adulthood and increase in severity. 1,2 In this issue of JAMA Pediatrics, Wang et al 3 report an updated meta-analysis evaluating the comparative efficacy of cognitive behavioral therapy (CBT) and pharmacotherapy for pediatric anxiety disorders. Results supported the efficacy of CBT, selective serotonin reuptake inhibitors (SSRIs), and their combination; limited support was provided for serotonin-norepinephrine reuptake inhibitors (SNRIs). We briefly review the evidence followed by implementation issues.Results of the meta-analysis indicate that CBT and SSRIs were each more likely to result in diagnostic remission/treatment response compared with wait list/no treatment and pill placebo, respectively. Combined CBT and medication led to greater improvements in anxiety symptoms compared with CBT alone (2 studies) or medication alone (1 study). Comparison of CBT and SSRIs (2 studies) indicated greater declines in anxiety (symptoms and diagnostic remission) among CBT-treated vs SSRI-treated children. 4,5 Some, but less, support was found for SNRIs on a few outcomes in some trials; there was no support for tricyclic medications, benzodiazepines, or buspirone. Adverse events and treatment dropout were more common during pharmacotherapy compared with CBT, although SSRIs and pill placebo did not statistically differ in dropout rates, dropout due to adverse events, or any specific adverse events. With regard to psychiatric adverse events, no suicide deaths or attempts were reported in any study and suicidal behavior appeared to be less than in