This paper studies the causal effect of having additional children on the elderly’s healthcare utilization using data from rural China. Overall, having more children increases the probability and out-of-pocket expenditures of using formal and informal healthcare, and the probability of forgoing necessary inpatient care. These results can be explained by deteriorating health that drives up the demand for healthcare, and increasing financial and social supports from children which facilitate healthcare use. The increased health costs from having more children are borne disproportionately by women and lower educated parents who have limited economic resources and less generous health insurance. On the other hand, though fertility imposes a heavier financial burden of medical care on the household, parents are more satisfied with the parent-child relationship, and more confident in their life-expectancy conditional on health status.