In pediatric chronic illness, little is known about the relational interactions between adolescent patients, parents, and illnesses and how they influence self‐management of illness. We conducted interviews with 32 individuals (16 dyads) representing adolescents diagnosed with a chronic illness and their primary parent who had been referred to a psychosocial treatment program for challenges with illness management. Interviews were conducted individually and analyzed dyadically using grounded theory to better understand the relational processes that may be contributing to illness management difficulties. Results include a theory of patient–parent illness responses and how parental illness meanings play a role in adolescent self‐management. Results can be used to better understand and treat family relational patterns that may be influencing pediatric illness management challenges.