Background: Pediatric nurses spend a considerable time on IV cannulation procedures for children. It often requires the involvement of experienced nurses to perform this procedure Purpose: To examine the effect of Valsalva Maneuver application versus Virtual Reality use on children's pain intensity during peripheral cannulation. Design: A quasi-experimental research design was used. Setting: The study was conducted at the Emergency Department of Alexandria University Children's Hospital El Shatby. Sampling: 150 children who attended the previously mentioned settings were included in the study.Instruments: Three instruments were used (Children's Characteristics and their Medical Data Assessment Sheet, Faces, Legs, Activity, Cry, Consolability (FLACC) Pain Assessment Scale and Wong–Baker Faces Pain Rating Scale). Methods: All children in the three groups were received routine hospital care. While the study group I applied the Valsalva Maneuver and study group II used the Virtual Reality Goggles. Results: Although 80% of children in the control group had observable severe pain, only 16% of children who had VM and none of children who had VR had severe observable pain. Moreover, 80% of children in the control group perceived intense pain compared to 16% and none of children in the VM and VR groups respectively Conclusions: Both Valsalva Maneuver and Virtual Reality were effective in decreasing children's observable pain as well as pain intensity during peripheral cannulation. Recommendations: Pediatric nurses in the emergency department should be trained to use different non-pharmacological pain management modalities such as Valsalva maneuver and Virtual Reality to decrease children's suffering during peripheral cannulation.