Introduction
It is estimated that up to 31% of children under 18 years of age have a chronic illness and up to 6Æ5% have a disabling chronic condition (Adams & Marano 1994, Newacheck & Halfon 1998). This special population and their families have a variety of medical, developmental, social, emotional, and environmental needs and issues that require comprehensive case management and long-term health care (Grey & Sullivan-Bolyai 1999). Congenital heart disease (CHD) occurs in eight of every 1000 live births, and about 32 000 babies with CHD are born each year in the United States of America (USA) (Burton & Cabalka 1994, American Heart Association 2000). With advances in medical and surgical management of CHD, it is becoming more common in chronic illness in childhood. However,familiesofchildrenwithCHDhavespecialproblems that produce anxiety and distress regardless of the severity of the congenital heart defects or the presence of other health or social problems (Emery 1989, Lobo 1992). Prior research has suggested that families who have chronically ill children experience excessive parental stress with no differences in stress according to the different chronic diseases (Goldberg et al. 1990, Kazak & Nachman 1991, Holden et al. 1997). There is little empirical research that has systematically examined differential impact on the family, based on characteristics of the chronic condition