Research points to parental incarceration as a social determinant of child health. Still, the extent to which the elevated health burden of children exposed to parental incarceration impacts parenting stress remains unclear. The current research addresses this gap in the literature using recent data from the 2016–2020 National Survey of Children's Health - a nationally representative sample of non-institutionalized U.S. children ages 0 to 17. Findings reveal a direct association between children's exposure to parental incarceration and multiple parenting stress indicators, including finding the child difficult to parent, feeling irritated by the child, feeling angry with the child, and parenting coping challenges. Notably, mediation analysis revealed that, collectively, child health and health care strains account for approximately 45% of the association between children's exposure to parental incarceration and the overall stress of parenting the focal child. Findings demonstrate how children's exposure to parental incarceration can have broader ripple effects on other family members by shifting child health and health care burdens in ways that heighten parenting stress. The findings underscore the health and health care needs of children with incarcerated parents as a top criminal justice and public health priority.