<sec><title>BACKGROUND</title>Pesticides are used to control pests, but they are toxic and may severely harm children's health. We assessed health outcomes in Italian children living close to cultivations sprayed with pesticides.</sec><sec><title>METHODS</title>In 2011-2012, 2,367 schoolchildren (6-14 years) living in eight Italian cities participated in the Indoor-School observational study. Parents filled in a standardised questionnaire on children's health and related risk factors. Children were classified as exposed to pesticides if living close to cultivations sprayed with pesticides. The association between the last three months of respiratory, allergic or systemic symptoms and pesticide exposure was assessed by multinomial logistic regression models, accounting for host/environmental risk factors.</sec><sec><title>RESULTS</title>Overall, 14% of children were exposed to pesticides, with significant differences among geographical areas: 21.2% in Northern Italy, 11.6% in Central Italy, and 9.7% in Southern Italy. Pesticide exposure was significantly associated with having: 1) 'often': eye symptoms (OR 3.81, 95% CI 2.06-7.05), skin symptoms (OR 2.60, 95% CI 1.34-5.03), lower airway symptoms (OR 2.38, 95% CI 1.41-4.01), systemic symptoms (OR 1.56, 95% CI 0.96-2.53, borderline); 2) 'daily': upper airways symptoms (OR 2.25, 95% CI 1.25-4.07) and systemic symptoms (OR 2.76, 95% CI 1.43-5.34).</sec><sec><title>CONCLUSIONS</title>Self-reported pesticide exposure was associated with respiratory, allergic or systemic symptoms in children. Public authorities should be aware of and intervene to mitigate this health risk.</sec>.