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We study the differences in utilization patterns of Emergency Room (ER) services by infants – babies between 0-1 years of age – comparing natives and migrants. We use administrative data relative to the Metropolitan area of Milan (Italy), involving more than 45,000 babies and covering the years 2015–2016. The main findings point to a higher propensity to use ER services by migrants, who are also associated with a higher risk of inappropriate admissions. This also holds after controlling for selection effects and excluding trauma episodes. When we explore the potential mechanisms driving these results, we find that linguistic and cultural distance between natives and migrants is a key factor in explaining the higher and inappropriate use of emergency care. Conversely, supply-side factors do not seem to play a relevant role. These findings suggest that integration policies aimed for instance at increasing the language proficiency of immigrants would help improve the appropriate use of emergency care.