ISSUES AND PURPOSE: Distraction during painful procedures has been shown to be effective in previous studies, yet this simple intervention is not used routinely. This study examined the effectiveness and feasibility of distraction in reducing behavioral distress, pain, and fear during venipuncture or intravenous insertion. DESIGN AND METHODS: A two-group randomized design with 384 children in 13 children's hospitals. RESULTS: Age was a significant factor in observed behavioral distress, reports of fear, and self-reported pain. The use of a kaleidoscope, however, did not significantly reduce pain or distress during venipuncture or i.v. insertion. PRACTICE IMPLICATIONS: Failure of the distraction intervention to reach statistical significance in this study is puzzling, given anecdotal reports of clinical efficacy. Methodological issues may have obscured actual differences between experimental and control groups.