Despite prevalence rates as high as 9.4%, few studies have examined the applicability of cognitive-behavioral therapy for treatment of anxiety disorders in very young children (i.e., below the age of 7 years). The present study examined the preliminary efficacy of a parent-led exposure therapy protocol (PLET) designed for young children with anxiety disorders. Twenty-two youth aged 4–7 years and their parents participated in this pilot randomized control trial. Families of youth with significant anxiety concerns were randomized to either PLET (n = 12), a 10 session/5-week family-based exposure therapy program designed to target anxiety in young children, or treatment as usual (TAU; n = 10). Children in the PLET condition demonstrated a greater reduction in anxiety symptoms compared to TAU (d = 3.18), with 90.91% of PLET participants (active condition) being classified as treatment responders at post-treatment as opposed to 0 in the TAU condition. Gains were maintained at 1 month-follow-up. Although pilot in nature, these data suggest in a preliminary fashion that a parent led exposure therapy protocol that is adapted appropriately for developmental age and incorporates an active coaching component for parents may be efficacious for the treatment of young children with anxiety disorders. This clinical trial was registered through clinicaltrials.gov under the following identifier: NCT02051192.