American Indian family caregivers of children with asthma face numerous barriers to effective management of the illness. The purpose of this qualitative, community-based study is to identify those barriers as perceived by family caregivers in a large Midwestern city. An ecological perspective and principles of family-centered care provided the theoretical orientation for the study. Interviews were conducted with 16 urban Ojibwe family caregivers of children with asthma. Five categories of barriers characterize the families' experiences: provider (individual and system), condition-related, family caregiver, socioeconomic, and environmental. Examination of these findings suggests directions for improving care to American Indian children with asthma and their families.