Surgical experiences are always stressful for both children and parents. Preoperative anxiety in children is very common. The aim of this study was to evaluate the effect of parent active participation in anesthesia induction on the preoperative anxiety levels of 120 children who were scheduled for elective orthopedic surgery at EL Hadara Orthopedic University Hospital. Children were randomly assigned to two groups. The experimental group intervention included parent active sharing in anesthesia induction, whereas the other group of parent attended anesthesia induction. The primary outcome was anxiety during induction of anesthesia (modified Yale Preoperative Anxiety Scale). Secondary outcomes were self-reported and observed pain, emergence delirium, need for rescue analgesia and parental anxiety. When compared with the other group, the results showed that children and parents in active participation group experienced significantly decreased anxiety levels (P < .001). Parent active participation reduces children’s preoperative anxiety and improves their compliance with induction of anesthesia.