Sedentary lifestyles pose a threat to the health of children, especially those with special health care needs (SHCN). Using data from the 2007 National Survey of Children's Health, this study examined relationships between parental attitudes and low physical activity and high screen time among 6- to 17-year-olds with and without SHCN. Perceived limitation was associated with increased likelihood of low physical activity (AOR, 1.339; 95%CI, 1.079-1.662). Parenting stress (AOR, 1.189; 95%CI, 1.052-1.344) and lack of trust (AOR, 1.243; 95%CI, 1.104-1.399) were associated with increased likelihood of high screen time. Perceived limitation modified the effect of special health care needs status on high screen time. The likelihood of combined low physical activity and high screen time was greatest among children with SHCN whose parents reported both functional limitations in the child and parenting stress (AOR, 2.659; 95%CI, 1.741-4.060). Parental attitudes and SHCN should be addressed in interventions to promote active lifestyles.