Why I'm having only one kid

And why that decision sometimes feels lonely

I saw a patient recently whom I hadn’t seen in a few years. He’s a jolly man in his 70s, always smiling and ribbing me about the co-pay.

“How’s that baby of yours, Doctor G?” he said. Had he really last seen me when I had just given birth?

“He’s four! Not a baby any longer,” I told him.

“Are you going to have another?” he asked.

I arranged my face in a semblance of neutrality. Brace for it, I told myself. Don’t let him get you riled up.

“No,” I said. “I think we’re a one-child family.” I pulled out my phone. “Here, let me show you a picture.”

“Whoa,” my patient said, throwing up his hands. “You can’t have just one! That’s no good for kids!”

I gave him a tight smile. Be professional, be professional! “I think we’re good with just one.” I turned to the computer. “Let’s talk about your recent labs.”

“No, no!” He was getting riled up. “Kids need brothers and sisters! It makes them weird to be all alone.”

“Well, we’ll see. We can’t predict the future,” I said. We can’t, but can I tell you about some very reliable methods of contraception?

“Let’s focus on your labs.”

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This kind of interaction is not uncommon. While I’m lucky that most people in my life don’t share such colorful commentary on my fertility choices, every few months, the judgment pops up.

“Oh come on, you gotta have another.”

“Kids were meant to have siblings.”

(As an aside: This kind of comment often comes from my patients! There’s a whole genre of social media content that’s basically “I’m a doctor and here are all the ways my patients treat me like crap.” That isn’t really my style, but maybe in it there’s an essay for another time: Why do my patients feel compelled to comment on my body, my family structure, my religion, the neighborhood I live in? Is it because I know so much about their private lives?)

So to cope with all this, I talk to my friends who also only have one kid.

My friend Amy’s child is a few years older than mine, and he treats my preschooler with an air of mentorship. We have one son each, wild and hilarious boys who both love spaceships and sharks.

“Please watch my Legos for me,” he tells him, and my son basks in the responsibility, beaming with pride to have the attention of an older kid. It’s almost — almost — like they’re brothers.

But they aren’t. For different reasons, both of our families have made the decision to have only one child. It’s a choice that feels lonely, at times, but mostly right. We’re part of a fundamental change in American family structure, as women choose to have fewer kids. And as pundits wring their hands about declining global fertility rates and wonder how to design policy to encourage people to have more babies, I can’t help but feel a little bit like they’re missing the mark.

Because every day, it seems, there’s another story in the news about why life is so difficult for American parents. They’re more stressed than ever. Having kids, every article seems to say, makes you miserable and overwhelmed. Even the surgeon general says American parents aren’t doing so great.

The Trump Administration and anti-abortion activists are making it deliberately worse, attacking maternal health and family planning, then gutting funding for childcare programs. It’s almost like the people in power hate women and families.

Amy and I text these articles back and forth to each other, along with some dark humor to get through the existential dread of it all: “Have more than one child, and sign yourself up for years of therapy,” we say. There’s an obvious path to avoiding all this heartache, we joke — stick to just one.

(And to be clear, I don’t actually believe that having only one kid is a solution to the all-out war on parents and children coming from the federal government. Many, many of my loved ones have multiple kids and are doing great. It’s just a depressing little jokey joke to cope with near-constant attacks on my bodily autonomy and personhood.)

The truth is, my decision to have only one child is one that has given me enormous freedom, but also is one that sometimes makes me deeply sad. And as more and more of my friends confess, “We aren’t planning on having any more kids, either,” I’m learning that the growth of one-kid families may have ripple effects for generations.

Like all American parents, I feel like it’s all a lot.

I am a full-time family physician and medical educator, and my spouse also works full time. Our son is a handful, as all kids are, and we often have to make impossible choices.

On more than one occasion, I’ve had to cancel a full day of scheduled patients to pick up my son from preschool when he developed a fever. I’ve also experienced the opposite, and equally agonizing scenario: I’ve been stuck at work while my son is home sick, feeling guilty and anxious that I couldn’t be there with him.

I have to think carefully about taking on new responsibilities at work, and exactly how much ambition my home life can handle. Then, I imagine which of my son’s milestones I might miss out on if I work too much. Like all working parents, I feel the push and pull of both my maternal and professional identities.

But having only one child has allowed me to start to think of these dual identities as complements to one another. Contrary to what you might imagine if you read the glut of harrowing parenting articles that fill my inbox, I don’t always feel like these roles are at odds. In fact, I’ve come to see them as symbiotic.

Being a mom takes pressure off of my role as a physician. When my son was born, I felt enormous relief to find meaning in something other than my career. For years, I had tried to think of my work as a spiritual calling. While I find medicine gratifying, it often falls short of that lofty standard. Parenthood opened a new world to me, a sense of both responsibility and joy. If I have a bad day at work, I return home to a gleeful kid who genuinely believes he is Spiderman.

And being a doctor alleviates some of the demands of parenthood. My primary care clinic is a sanctuary of calm compared to my home when my son is throwing a tantrum. Work is a welcome respite from the tedium inherent in spending extended time with a young child. I love my son’s teachers, and I feel no ambivalence in announcing how grateful I am that they allow me time apart from him.

This balance, I believe, is made possible by my family’s choice to have only one child.

But sometimes that decision feels like a sad one, made out of necessity. Parenting an only child wasn’t something I always dreamed of. My husband and I arrived at the decision over time, in repeated conversations about our careers, and climate change, and what we wanted our community to look like. Like many of our peers, we had delayed childbearing until after we finished years of graduate education, another factor that made having multiple children less likely.

My husband and I talk seriously about the concerns of having a one-child family. Well-meaning family and friends worry about our son, and they worry about us adults, too. “Who will take care of you when you get old?” they ask. “Will being an only child make him selfish, or weird?” I worry about all of those things, too. I also trust I’d worry about them just as much if I had three kids instead of one.

Sometimes I feel pangs of jealousy for a life with more children of my own when I cuddle a friend’s baby, or take care of a newborn patient at work. It’s what the writer Cheryl Strayed calls the “ghost ship that didn’t carry us,” an alternative life where I made choices other than the ones that led me here. I also feel that ache when I see a childless friend’s photos of a trip to Italy, or find myself moved to tears by the kind of powerful art that can only be created when there are no little hands nearby begging for Goldfish.

There will always be lives not lived.

But mostly, my decision to have only one child has felt like a beautiful choice. I get the best of both worlds.

When my husband wants to go rock climbing with his friends, I hang out with our kid. When I go to book club meetings — a rigorous, monthly event where it is absolutely expected you’ve read the book — he does the same for me. We’re never outnumbered by misbehaving kids. There’s no conflict between an infant’s nap schedule and an older child’s karate lessons, because there’s only one little guy to keep up with. My life feels enough like a complex web of Google calendar invites without a newborn in the mix.

I am intentional about carving out unstructured time for my son to be with other kids, both his peers and those who are different ages. It’s forced me to be deliberate about building a community for him, and in turn, for myself. I want him to grow up with friends who feel like siblings, to have the tools to create a chosen family for himself. I try to cultivate this by opening my doors wide to our family and friends, letting them into the messiness of our lives.

Having only one child, perhaps ironically, has made me purposeful in rejecting the individualistic parenting norms of my fellow millennials. “Come on over,” I say to our neighbors. “Who cares if the kitchen’s a mess?”

I am trying hard to raise a son who invests deeply in his relationships. I do this not by bringing up my son with siblings, but by working to be a role model to him. This is how you show up for your people, I teach him, by bringing him along when I drop off homemade bread for a friend who’s had heart surgery, or hosting my aging parents for weekly meals.

Having siblings doesn’t make that investment less necessary. All relationships — all communities — take work, whether we’re related by blood or not.

In a recent episode of the Ezra Klein Show, in an otherwise familiar conversation about the challenges of American parenting, sociologist Caitlyn Collins said something offhand that struck me.

“I remember telling a girlfriend who was pregnant, ‘My daughter is so fun. I have so much fun with her.’ And she said, ‘Thank you for sharing that with me because no one has talked to me about it being fun to have kids.’”

Let me tell you, having one kid is so much fun. My son and I read books together and swim together, and then I leave him with my husband and go out to dinner with my child-free friends. I get to be fully present with my patients and my students, and think deeply about my writing. Then I go home and my kid and I make an art project made entirely of shark stickers.

I recognize how lucky I am to find both work and parenting possible, mostly because I can afford excellent childcare. That is a resource all families should have. I want a world where people can feel confident having one kid or six, where we all get paid parental leave and have forgiving work schedules. I want family-building resources for people who need medical technology to become parents, or cannot become pregnant at all. I want respect and community for those who have no kids, too. This principle is called reproductive justice, and it guides my work as a physician and the way I think about parenting.

But the reality is, I don’t live in that world. (I think it exists, and it’s called Sweden.)

Instead, I am part of a culture that’s in many ways hostile to children. Yet I also feel the pressure of an intensive mothering ideal that’s patently unachievable while I’m also working outside the home.

The way I cope with this impossible scenario is to parent one child, and only one. Having my son has changed my life for the better in countless ways, but he’s not the only person in it. Do I have it all? Of course not. But I have enough.

How do you think about family building in your life? Are you a child-free family, a one-child family, or do you have lots of kids? How do you make it work?