Introduction: Very few studies have been published on the clinical history and contagiousness of not hospitalized Covid-19 pediatric patients. Therefore, to get deeper in this topic, between October 2020 and March 2021, we carried out an observational study in the pediatric primary care setting in Italy. Methods: The study enrolled patients with Covid-19 disease (cases); patients with suspicious symptoms but negative swab; close contacts of Covid-19 cases. The follow-up was 28 days for patients with Covid-19 disease, 14 days for the other subjects enrolled. Results: 1947 patients aged 0-13 were enrolled: 465 with Covid-19 disease; 549 with suspicious symptoms but negative swab; 933 close contacts of Covid-19 cases. 130 subjects with Covid-19 were asymptomatic at the time of diagnosis. Among the others, in children aged 0-2 the most frequent symptom was rhinitis (41%) followed by fever (38%) and cough (31%). In children aged 3-13 the most frequent symptom was headache (30%) followed by rhinitis (23%), asthenia (18%), fever (16%), cough (11%). No symptoms alone were sufficient to induce or rule out the suspicion of the Covid-19 disease diagnosis. A multiple logistic regression analysis, conducted for the purpose, allowed to build a score capable of inducing disease suspicion in patients older than 2 years of age, based on: fever, rash, rhinitis, headache and asthenia. Conclusions: This study compared subjects with SARS-CoV-2 infection with unaffected subjects with similar symptoms and confirmed that it is impossible to clinically distinguish Covid-19 from other similar respiratory diseases in pediatric age. The obtained score, potentially useful and valid during the study period, could not be applied in other epidemiological scenarios.