BACKGROUND Whereas the stress precipitated by the diagnosis of an infant's congenital abnormality is well recognized, this study examined parenting stress reported by parents of children older than 2 years with heart disease. METHODS Abidin's Parenting Stress Index was administered to parents of children ages 2 to 12 years with known heart disease during a cardiology outpatient clinic visit. RESULTS Parents of children with heart disease were more likely than the normative population to report excessive parenting stress, especially related to characteristics of the child that make them difficult to parent. Approximately 1 in 5 parents expressed clinically significant levels of stress. These parents expressed difficulty with setting limits or discipline of the child with heart disease. Parenting stress was not related to the severity of the child's heart disease, family socioeconomic status, or time since most recent surgery. Older age of the child was associated with higher parenting stress scores. CONCLUSIONS Clinicians must assess parenting stress at each health care visit to provide appropriate support and anticipatory guidance to families of children with heart disease.