Continuous subcutaneous insulin infusion (CSII) by external pumps is shown in several clinical trials to be a safe and effective treatment modality for patients with T1D. The present prospective observational study evaluated the efficacy and safety of CSII in children and adolescents treated in a routine clinical setting. 186 patients using CSII from 3 to 30 months were included in the analysis. A significant decrease of GlyHbA1c was observed after 3 months (p < 0.005) and was sustained throughout the study with a mean all over reduction of 0.7%. Events of ketoacidosis and severe hypoglycemia amounted to 0.027 and 0.014 per patient-year, respectively. Routine use of CSII in children and adolescents with T1D is effective in improving metabolic control and associated with a very low incidence of ketoacidosis or severe hypoglycemia.