Background: Virtual Reality (VR) play an integral role as a promising distraction technique for children's pain and anxiety management. Purpose: To assess the effect of virtual reality on pain and anxiety among school age children during vein puncture. Design A quasi-experimental design (study and control groups) was utilized. Setting The study was conducted in the pediatric department at Menoufia University Hospital, Shebin El-Kom City. Sample A purposive sample of 50 school age children who used the virtual reality goggle during vein puncture and 50 school age children who received only routine hospital care during the vein puncture. Instruments Four instruments used for data collection: A structured interviewing questionnaire for school age children, Wong–Baker Faces Pain Rating Scale, Facial Affective Scale (FAS)-Three Faces Facial Affective Scale and Feasibility assessment sheet. Results showed that there were highly statistical significant differences between levels of pain and anxiety on posttest compared to pretest (3.72 ± 2.86 Vs 7.32 ± 2.67 respectively) & (43.0 ± 33.52 Vs 78.0 ± 32.20 respectively). Also, children who received virtual reality distraction had less pain and anxiety than children who received routine hospital care (3.72 ± 2.86 Vs 6.80 ± 3.16 respectively) & (43.0 ± 33.52 Vs 64.0 ± 35.05 respectively). Conclusion: the application of virtual reality distraction had appositive effect on reducing pain and anxiety during the vein puncture among school age children. So, it was recommended that applying virtual reality goggle during the vein puncture in clinical setting to reduce pain intensity and anxiety level.