As pediatric sleep facilities and resources expand, increasing numbers of children with sleep-disordered breathing requiring continuous positive airway pressure (CPAP) treatment are being identified. Despite extensive expertise in treating adults with CPAP, many centres have little experience using CPAP in the pediatric population. The successful initiation and continued effective treatment with CPAP requires a unique and specialized approach to the pediatric patient and their family. Nearly, half of children needing CPAP will be uncooperative upon initial exposure to this unusual treatment. This review aims to outline an approach to the successful initiation of CPAP treatment in children including some trouble-shooting strategies to maximize initial and ongoing compliance with prescribed therapy.