A family systems model is presented for understanding adaptation and coping in childhood chronic illness. The importance of a systems perspective in work with children and families who may not display psychopathology is stressed. A general overview of systems and social-ecological theories relevant to children with chronic illnesses and their families is presented. Literature on stress and coping in these families is reviewed, then some of the unique issues that merit consideration in this area of research and intervention are examined. Finally, the importance of these models for responding to the growing number of families with children with AIDS is discussed.