The term self-esteem is frequently used by occupational therapists and other health care professionals who work with children. There are differing interpretations as to what this term actually means. In this article, we use Susan Harter’s model of self-esteem to define the nature of self-esteem and apply it to clinical practice. We outline the developmental characteristics important to consider when addressing the self-esteem of young children, such as the findings that young children’s self-esteem is often more related to their perceptions of parental acceptance than perceptions of competence and that children are generally unable to accurately verbalize their level of self-esteem until 8 years of age. Specific implications for occupational therapy evaluation include whether the use of self-report or observer-report measures is preferable and whether self-esteem or self-concept should be measured. We discuss when to address self-esteem and which dimensions of self-esteem should be treated. The dimensions of self-esteem that are identified as low during the evaluation and that the child perceives to be important are addressed. The reevaluation issue of what specifically should be measured after intervention is also discussed. For example, it is recommended that the reevaluation instrument be sensitive to the domains of self-concept targeted for intervention.