Much of the burden of providing health care and other services for children with rheumatic diseases falls on the parents, but little is known about the impact of these conditions on the family. A survey of the parents of 138 children revealed that the most important predictors of high family impact were the number of the child's activities of daily living that were limited by illness, the educational attainment of the mother, the child's sex, the mother's perception of the child's health, and the volume of medical care use. Our results provide guidelines for identifying families who are most vulnerable to the stress of having a child with a rheumatic disease.