The death toll in the Italian earthquake stands at 241 as thousands of rescuers continue efforts to find survivors.
Dozens are believed trapped in ruined Amatrice, Accumoli and Pescara del Tronto, in mountainous central Italy.
Rescuers have advised journalists and bystanders to leave Amatrice urgently, as “the town is crumbling”, the BBC’s Jenny Hill says.
New cracks appeared in the town’s hospital after strong aftershocks.
Officials revised down the number of dead after earlier giving a figure of 247.
The search for survivors went on through the night, amid hundreds of tremors and an aftershock which rocked already damaged buildings.
More than 4,300 rescuers are using heavy lifting equipment and their bare hands.
Many of the victims were children, the health minister said, and there were warnings the toll could rise further.
The heaviest death toll was in Amatrice – 184, officials said. Another 46 died in Arquata, and 11 in Accumoli.
The 6.2-magnitude quake hit at 03:36 (01:36 GMT) on Wednesday 100km (65 miles) north-east of Rome.
Some aftershocks were felt as far away as Rome.
“We are sleeping in the car and there were shocks all night. When the biggest one came, the car started moving and shaking,” said Monica, a survivor from Amatrice.
At the scene: BBC’s Damian Grammaticas in Pescara del Tronto
Two firemen burrowed deep into the rubble looking for a survivor. “It’s a dog,” one of them shouted out.
For half an hour the men kept digging. They passed water down to be given to the animal. And eventually they worked it free, then emerged, carrying it to the surface. There was a ripple of congratulations through the crowd.
“It doesn’t matter to us if it’s a person or an animal, we save it,” said Gianni Macerata, the fire officer in charge.
So the digging goes on. But so little is left of Pescara del Tronto it is unlikely that more survivors will be found here.
It seems unlikely too that this ancient little place, that has stood for centuries, can ever be rebuilt. Hundreds of years of history ended in an instant.
A tented camp has been set up, as so many buildings are now unsafe.
Prime Minister Matteo Renzi was chairing an emergency cabinet meeting on Thursday. The agenda included reconstruction plans for the devastated area.
Grief and anger in Italian press
Rescuers said they had pulled five bodies from the ruins of the Hotel Roma in Amatrice. As many as 70 tourists were staying at the hotel when the quake struck. Many are feared to be in the rubble, though several were pulled out and given medical care.
Many of those affected were Italians on holiday in the region. Some were in Amatrice for a festival to celebrate a famous local speciality – amatriciana bacon and tomato sauce.
Late on Wednesday there were cheers in the village of Pescara del Tronto when a young girl was pulled alive from the rubble after being trapped for 17 hours. Almost all the houses there had collapsed, the mayor said.
Among the victims was an 18-month-old toddler, Marisol Piermarini, whose mother Martina Turco survived the deadly 2009 earthquake in L’Aquila and moved away from there after the experience, Italian news agency Ansa reported.
Ms Turco was being treated in hospital after being pulled from the rubble in the village of Arquata del Tronto, Ansa said.
he mayor of Amatrice said three-quarters of the town had been destroyed and no building was safe for habitation.
The country is no stranger to earthquakes: the 2009 L’Aquila tremor killed more than 300 people and in May 2012 two tremors nine days apart killed more than 20 people in the northern Emilia Romagna region.