The death toll from the 6.2 magnitude quake has reached 250
At least 250 people have died in an earthquake which has devastated parts of central Italy.
The 6.2-magnitude quake struck the Lazio, Umbria and Le Marche regions in the early hours of Wednesday, leaving a trail of destruction.
Dozens of people are still believed to be trapped in Amatrice, Accumoli and Pescara del Tronto.
Thousands of people have also been left homeless by the disaster.
Sergio Pirozzi, mayor of Amatrice, said: "The town isn't here any more.I believe the toll will rise."
Many of the victims were children, Italy's health minister Beatrice Lorenzin said.
An 18-month-old girl was among the victims in Arquata del Tronto, while an 11-year-old boy died after the collapse of a hotel in Amatrice.
Rescue teams and volunteers have poured in from across Italy, using bulldozers and often their bare hands to pull people from the wreckage.
Meanwhile, Taoiseach Enda Kenny has written to Italian Prime Minister Matteo Renzi to offer Ireland's sympathies.
I have written to PM Renzi expressing sympathy w/ the Italian people, families & communities affected by dreadful tragedy in central Italy.— Enda Kenny (@EndaKennyTD) August 25, 2016
In Amatrice, volunteer Christian Bianchetti said: "Unfortunately, 90% we pull out are dead, but some make it, that's why we are here."
Some of the survivors have described apocalyptic scenes "like Dante's Inferno" after the quake, with buildings razed to the ground and dust and gas filling the air.
Tremors were strong enough to be felt 90 miles away in Rome, where authorities have ordered structural tests on the Colosseum.
More than 200 aftershocks jolted Lazio on Wednesday, some as strong as magnitude 5.1.
At 5.00am local time on Thursday a 4.5-magnitude aftershock struck Amatrice, where hundreds of people spent the night sleeping in cars or tents.
Monica, who is from the town, said: "We were sleeping in the car and there were shocks all night. When the biggest one came, the car started moving and shaking."
"But what have we got to lose now? We have lost our house. So many friends and family are dead. We have lost everything, even our fear."
Italian Prime Minister Matteo Renzi said that his cabinet would meet on Thursday to decide measures to help affected communities.
He said: "No family, no city, no hamlet will be left behind".
Paolo Fleming lives in Amatrice, where most of the town has been reduced to rubble.
A 10-year-old girl has been rescued from the rubble of the earthquake - after being trapped upside down for 17 hours.
A firefighter clutched her tightly to his chest after she was freed from the ruins of a building in the town of Pescara del Tronto.
Crowds had gathered round after one person spotted signs of life under the rubble, saying: "You can hear something under here. Quiet, quiet."
Footage shows her dust-covered legs poking out of the debris, with cheers breaking out as the pony-tailed youngster was eventually freed.
Jubilant rescuers shouted "she's alive" as she was carried away.
Firefighter Danilo Dionisi said: "The 10-year-old girl was just pulled out now from the rubble and she is being taken to the hospital and that is good news."
"As far as the rest is concerned, the images speak for themselves, you can see what the town looks like."
The frantic search for survivors is continuing, but there are fears the death toll will rise.
Rocks and metal fell on to the streets in the centre of Amatrice and dazed residents sheltered in piazzas as more than 40 aftershocks hit the region in the early hours.
The epicentre was northeast of Rome, near Norcia in Umbria, and sent tremors across the rural central spine of Italy.
Guido Bordo (69) lost his sister and her husband after they were trapped inside their holiday house in the hamlet of Illica, near Accumoli.
"There's no sound from them, we only heard their cats," he said, before their deaths were confirmed.
"I wasn't here. As soon as the quake happened, I rushed here. They managed to pull my sister's children out, they're in hospital now."
Two boys aged four and seven were saved by their grandmother, who ushered them under a bed as soon as the shaking began, reports said. She also survived but lost her husband.