Abstract Children with leukemia are subjected to pain during various procedures. Distraction is one of the easiest and least costly methods of non-pharmacological pain relief. This study aimed to identify the efficacy of distraction on pain relief during lumber puncture in children with leukemia. Methods: A quasi experimental research design conducted among 90 patients at South Egypt Cancer Institute - Assiut University. children were allocated to either breathing, colored cards, or control group, thirty child for each group .Two tools were used, Tool one: Structured interview sheet to collect socio - demographic data and tool two where children's pain was assessed by FLACC scale. Findings: Pain score in the breathing and colored cards groups was highly significantly lesser than the control group. There was no significant difference between the two sexes while as the age increases, the tolerance to pain increases too. Conclusion: This study showed that breathing exercises and colored cards can significantly reduce the pain of intrathecal injection. Recommendations: Considering the key role of nurses in a health care team, the researchers hope that the results of this study can help them learn this method and implement it in hospitalized children who undergo painful procedures.