Over one in five households with children has at least one child with a special health care need (CSHCN). Child health caregiving can bleed into paid work time. This research analyzes what factors influence work decisions (who reduces work and by how much) in married-couple families with CSHCN. This article uses data from the Medical Expenditure Panel Survey to examine the specifics of changes in parental work status and a comparison of family/work trade-offs made by parents in families with and without a CSHCN. Results indicate that mothers are more likely to experience negative work changes than fathers. Both mothers and fathers with CSHCN are more likely to report missing work than parents of children without special health care needs. Overall, when children receive treatment in a primary care practice that serves as a medical home, parents are less likely to experience negative employment changes.