Background: Research has examined family functioning in relation to childhood chronic conditions; some findings suggest a detrimental impact of illness on functioning, others suggest no impact or instances of improved functioning. This review collated qualitative data, to understand the factors facilitating healthy functioning. Method: Four electronic databases were searched: Web of Science, Medline, CINAHL and Psych INFO and ten papers were identified. Results: A meta-ethnographic synthesis showed that families encounter a variety of potential stressors, such as distress following diagnosis. They manage these through various resources including contact with health services. The synthesis highlighted an appraisal process mediating the perception of stressors and resources. This process occurs on interconnected levels (individual, family and wider system) and it is this, rather than the specific stressors or resources encountered, that impacts functioning. Discussion: The challenges commonly encountered by families managing childhood chronic conditions can be experienced very differently depending on their systems of appraisal. This has clinical implications as health services should not only offer holistic support to families but regularly review how this support is perceived. Research could be extended to investigate which factors promote a more positive appraisal of challenging situations.