Background The clinical and emergency care daily activities show that only a fraction of children with urgent surgical pathology access to dedicated paediatric centres while most of the diagnostic, therapeutic and emergency care takes place at facilities not necessarily specialised in the treatment of paediatric acute illness; as it should be as per regional and national legislation.

Objective Analyse the care pathways of children hospitalised for urgent surgical pathology (appendicitis, hypertrophic pyloric stenosis).

Materials and methods Structured survey delivered to 93 hospitals in Lombardy.

Results The response rate was equal to 79.7%, corresponding to 74 facilities: the appendectomy was performed in 90.5% (n = 67) and the surgical correction of HPS was performed in 17.6% (n = 13) of cases.

The hospitalisation was in 14.9% of cases (n = 10) at the paediatric surgery department, 56.7% (n = 38) at paediatrics department, 4.5% (n = 3) at general surgery department having rooms dedicated to children and 23.9% (n = 16) at general surgery department without paediatrics dedicated rooms.

Discussion The analysis shows that the regional and national legislation is disregarded: it is alarming the attitude of 19 hospitals that hospitalise children in unsuitable environments, with rooms shared with adults and aged patients and the correlated risk of adopting care pathways "not dedicated and unsafe " for children.

Conclusions It’s desirable an adjustment of the hospital facilities to promotes the creation of a culture in paediatrics able to ensure the highest levels of care in such a vulnerable age.