Children of parents with chronic pain are a high-risk group to develop own chronic pain. There is evidence that parental responses such as catastrophizing and solicitousness play an important role in the familial transmission of chronic pain. However, little is known about factors that modulate these responses. Based on the literature, we assumed that top-down processes, such as parent chronic pain and anxiety, would be associated with increased catastrophizing and solicitousness. Bottom-up processes, such as child chronic pain and anxiety, were assumed to moderate this association. N = 118 parents (mean age: 43 years, 80.5% females) with chronic pain and/or anxiety symptoms with N = 190 children (mean age: 11 years, 49% females) were recruited in specialized hospitals and via online panels. Parents reported chronic pain, anxiety, catastrophizing, and solicitousness by use of validated questionnaires. Child pain and anxiety were assessed via parent report. Multilevel model results showed that top-down processes, rather than bottom-up processes, predicted parental responses to child's pain. Specifically, parents with more severe chronic pain reported less catastrophizing. Parent anxiety was positively associated with parental catastrophizing and solicitousness. While child chronic pain and anxiety did not exert an impact on parental responses, the parents' and child's age emerged as additional modulating factors for parental solicitousness. Findings support the assumption that top-down processes, particularly parent anxiety, rather than bottom-up processes, exert an impact on parental responses. Specific interventions to decrease parent anxiety in the context of chronic pain and effects of adult treatment on parental responses to child's pain warrant further investigation.