Background Based on findings from adults with obsessive‐compulsive disorder (OCD), this study examined alterations in resting‐state functional connectivity (rs‐fc) between the basolateral amygdala (BLA) and the ventromedial prefrontal cortex (vmPFC) in children and adolescents with OCD. We also assessed whether such BLA‐vmPFC connectivity changed with or predicted response to exposure and response prevention (E/RP), the first‐line treatment for pediatric OCD, given the involvement of these regions in fear processing, regulation, and extinction learning—a probable mechanism of action of E/RP. Methods Resting state functional magnetic resonance imaging scans were acquired from 25 unmedicated, treatment‐naïve pediatric patients with OCD (12.8 ± 2.9 years) and 23 age‐ and sex‐matched healthy controls (HCs; 11.0 ± 3.3 years). Patients completed a 12–16‐week E/RP intervention for OCD. Participants were rescanned after the 12–16‐week period. ANCOVAs tested group differences in baseline rs‐fc. Cross‐lagged panel models examined relationships between BLA‐vmPFC rs‐fc and OCD symptoms pre‐ and posttreatment. All tests were adjusted for participants' age, sex, and head motion. Results Right BLA‐vmPFC rs‐fc was significantly reduced (more negative) in patients with OCD relative to HCs at baseline, and increased following treatment. In patients, more positive (less negative) right BLA‐vmPFC rs‐fc pretreatment predicted greater OCD symptoms reduction posttreatment. Changes in BLA‐vmPFC rs‐fc was unassociated with change in OCD symptoms pre‐ to posttreatment. Conclusions These results provide further evidence of the BLA‐vmPFC pathway as a potential target for novel treatments or prevention strategies aimed at facilitating adaptive learning and fear extinction in children with OCD or subclinical OCD symptoms.