Background: Children undergoing hemodialysis expose highly to anxiety and pain from frequent punctures. Valsalva maneuver is one of non-pharmacological nursing interventions to decrease pain intensity. Aim: The study aimed to evaluate effectiveness of Valsalva maneuver on pain intensity and anxiety in children undergoing hemodialysis. Design: A quasi-experimental design was used on a purposeful sample of 60 children with chronic kidney disease and undergoing hemodialysis who attended at the dialysis unit in Assiut Children University. Method: The present study data were collected by using a structured questionnaire sheet about personal characteristics, clinical data of children, Wong–Baker faces pain rating scale for children, physiological measures of pain and anxiety symptom scale short form. Results: The results indicated a highly statistical significant difference between the study group Valsalva and the control groups regarding post-test pain level (P= 0.001) as the highest percentage (63.3 %) of the Valsalva group had a mild pain level compared to only 3.3 % in the control group. A highly statistical significant difference between the groups was found regarding post intervention anxiety levels (P= 0.001) as nearly two thirds (63.3 %) of the Valsalva group had a moderate level of anxiety while, the majority (96.7 %) of the control group had a severe level of anxiety. Conclusion: Valsalva maneuver is an effective non-pharmacological nursing intervention in reducing pain from AVF cannulation and pain related anxiety for children undergoing hemodialysis. Recommendations: Using Valsalva maneuver is recommended before AVF cannulation for reducing pain and anxiety in children undergoing hemodialysis.