OBJECTIVE: The purpose of this study was to better understand occupational therapists' experiences of making a difference in parent-child relationships. METHOD: In this qualitative, instrumental case study, occupational therapists working in early intervention were asked to reflect on and describe occasions in which they believed that they made a real difference in parent-child relationships. The primary investigator interviewed nine experienced pediatric occupational therapists. RESULTS: All nine therapists highly valued the parent-child relationship and focused on these relationships in therapy. Eight themes emerged that described the therapists' practice insights and methods by which the therapists facilitated the parent-child relationship. CONCLUSION: The occupational therapists in this study reflected insights that resonate with the literature regarding the role of the parent-child relationship in the development of children. The authors raise the question about the adequacy of instruction at the pre-service level that prepares therapists to both assess and facilitate the parent-child relationship in early intervention.