This study examines patterns of literacy-related activities in families with children with special healthcare needs (CSHCN) and factors associated with frequent book-sharing activities and obstacles to reading experienced by these families. Primary caretakers of CSHCN were interviewed to characterize book-sharing activities and to determine obstacles to reading. Parents were categorized as reading frequently on the basis of specific criteria. Factors associated with reading frequently were examined. We found that 90% of parents reported reading to their child at least once a week; 33% read daily. Parents reported spending as much time in medical-related activities as reading. Parents were more likely to read frequently to their child if their child was developing typically (OR = 2.5, P = .03) or if they had a greater number of books at home (OR = 1.02, P = .04). Of the 11% of parents who did not read to their child, almost 60% felt that their child would not enjoy being read to, and 21% felt that they did not know how to share books with a child with special needs. We conclude that although most parents of CSHCN share books with their children, some parents experience obstacles to reading that can be areas of intervention during primary care visits.