This guide answers the questions of the first few months: registering a child with the national health service, the paediatrician of free choice, the vaccination schedule, well-child checks, costs, dentistry and emergencies.

The paediatrician of free choice

In Italy children don’t see the adult family doctor. They have a pediatra di libera scelta — a paediatrician contracted to the national health service who treats them free of charge.

Up to what age

• From 0 to 6 the paediatrician of free choice is compulsory

• From 6 to 14 the family chooses between the paediatrician and the family doctor

• At 14 the move to a family doctor becomes the rule, with extensions to 16 in particular situations, such as a chronic condition

How to choose

You choose at the ASL or through your regional portal, from the list of paediatricians with places available in your district. You need the child’s tessera sanitaria, the tax code and proof of residence. Changing paediatrician is possible at any time and needs no explanation.

In large cities the constraint is availability: few paediatricians have open lists and they fill quickly. Sort it out as soon as residence is registered, not at the first fever.

What the paediatrician does

Sick visits, scheduled bilanci di salute, vaccinations, certificates, prescriptions and specialist referrals. They decide when hospital input is needed, and their referral is what reduces a specialist appointment to the co-payment rather than the full fee.

Outside surgery hours there is the out-of-hours service, and for questions that don’t need a physical examination — a rash, how to manage a fever, clarifying a dose — an online consultation with a paediatrician saves an evening in a waiting room.

Vaccinations

The ten compulsory ones

Italian law provides ten compulsory, free vaccinations for children up to sixteen:

• Polio

• Diphtheria

• Tetanus

• Hepatitis B

• Whooping cough

• Haemophilus influenzae type b

• Measles

• Mumps

• Rubella

• Chickenpox

The requirement has an immediate practical effect: without vaccination records, children aged nought to six cannot be enrolled in nursery or kindergarten. From six to sixteen enrolment is allowed, but non-compliance carries penalties.

Recommended, and also free

Not compulsory but offered free by the health service and recommended by paediatricians: meningococcal B and ACWY, pneumococcal, rotavirus, and HPV — offered around age eleven or twelve to girls and boys alike.

If your child was vaccinated abroad

Vaccinations given in another country are recognised. You need the record with dates and vaccine names, ideally translated. The paediatrician or the ASL vaccination centre compares the doses against the Italian schedule and gives only what is missing — nothing restarts from zero.

Well-child checks

Bilanci di salute are the scheduled check-ups of a healthy child, free and part of the paediatrician’s role. Most fall in the early years and they continue, more widely spaced, into adolescence.

At each stage they check weight, height and head circumference, motor and language development, vision and hearing, feeding and sleep. They are also when the vaccination schedule is updated and developmental problems are picked up early.

They are worth keeping precisely when the child is well — that is what they are for.

What it costs

Appointments with the paediatrician of free choice are free. The ticket applies to specialist care and diagnostics, and the amount is set regionally.

The exemptions that matter most to families:

• Children under six in households within the income threshold (€36,151.98), under a dedicated exemption code

• Recognised chronic conditions, for related care

• Rare diseases

An exemption has to be applied for or self-certified, and it goes on the referral. Check it before booking a test: on a single procedure the difference runs to tens of euros.

Privately, a paediatric appointment usually costs €80–130 and a paediatric specialist €100–150.

Dentistry

Dentistry is the system’s most visible gap. Children’s dental care is only partly covered and varies sharply by region: some guarantee check-ups, sealants and fillings up to fourteen, others cover only emergencies and cases with associated conditions.

In practice most families use a private dentist, from €50–80 for an appointment. Supplementary policies with dental cover are common for exactly this reason.

Certificates: sport and school

Non-competitive sport (attività non agonistica) requires a fitness certificate, issued by the paediatrician or family doctor and free for their own patients. Competitive sport (agonistica) requires an appointment in sports medicine, which is chargeable and includes an ECG.

The certificate for returning to school after illness has been abolished in many regions but not all: some still ask for it after a set number of days. Check with the school office, because the rule is not national.

Emergencies and out-of-hours problems

When to call 112

112 is the free single emergency number. Call it for breathing difficulty, seizures, loss of consciousness, significant injury, marked dehydration, or a very high fever in an infant that doesn’t respond to medication.

In emergency departments children are assessed by severity, not arrival order: since 2019 the codes are numeric, from 1 (immediate) to 5 (minor). Many hospitals have a dedicated paediatric emergency department.

When the emergency department isn’t the answer

A fever that responds to antipyretics, a cold, a sore throat, conjunctivitis, a rash with no other symptoms — the paediatrician handles these in the surgery, or the out-of-hours service outside opening times. Several of them can also be handled remotely: allergy treatment, the atopic dermatitis that returns every winter, conjunctivitis picked up at nursery, or a cold that isn’t clearing.

The rule is simple: signs of severity go to the emergency department, everything else starts with a medical assessment, in person or online.

What to prepare

• The child’s tax code and tessera sanitaria

• SSN registration and choice of paediatrician, as soon as residence is registered

• The vaccination record from your previous country, with dates and vaccine names

• Any co-payment exemption you qualify for

• Numbers: 112 and your district’s out-of-hours service

Italian paediatrics is among the strongest in Europe precisely because it is built around the healthy child: scheduled checks, free vaccinations, a dedicated doctor for the early years. The entry cost is bureaucratic, and you pay it once.