This paper presents a review of the literature on stress and coping in families with children having spina bifida and offers a transactional model to study the parent child interaction in these families. The conclusions drawn from the literature review are the following: both parent and child in the family setting need to be considered as both face unique specific stresses; there has been little research dealing specifically with this population; current family stress research and research on parent and sibling reactions to the spina bifida child indicates that parents often experience tension, isolation, fatigue, depression, and financial problems and siblings are often characterized by excessive investment in the handicapped child; and the child's mode of ambulation and intellectual development may be important sources of family stress. Studies of adolescents with spina bifida have indicated common social isolation, low self esteem, and feelings that their parents do not understand the disability. The transactional model offered focuses on the relationships between the child's coping strategies, the stress which these strategies generate for family members, the subsequent coping strategies of parents and siblings, and the resulting chain reaction. (27 references) (DB)