Background: Illness, hospitalization, and surgery are the first crises that children face especially during the early years. The play and passive distraction technique are non‐pharmacological approach used to control emotions. They are considered an anxiety-reducing strategies that divert children's attention away from noxious or unpleasant stimuli and subsequently minimizes their anxiety and fear. Objective: To determine the effect of play activities versus passive distraction techniques on preoperative anxiety and fear levels among children undergoing surgeries. Setting: The study was conducted in the general pediatric surgical units at Alexandria University Children at El-Shatby and Smouha Specialty Hospitals. Subjects: A convenience sampling of 90 hospitalized school-age children undergoing general surgeries were included from the previously mentioned settings. Tools: Three tools were used; Socio-demographic and medical data of Children's structured Interview Schedule, State trait anxiety inventory for children (STAIC), and the children's fear scale (CFS). Results: These results revealed that 66.7% of school-age children in the play activities group and 30% of children in the passive distraction group had low anxiety compared to none of them in the control group (0.0%). In addition, 66, 7% of school-age children in the control group had extreme fear compared to none of those children in both the play activities group and the passive distraction group. A highly statistically significant difference was detected for the preoperative anxiety and fear between school-age children in both groups (I and II) one hour before surgery. Where 50% of children in study group II mentioned that they had average anxiety compared to 33.3% of them in study group I. In addition, nearly half of the children in study group II reported that they had medium fear (46.7%) compared to 16.7% of them in study group I. Conclusion: Practicing the play activities and passive distraction technique for school-age children preoperatively minimized their level of anxiety and fear. In addition, the play activities were more effective in decreasing children's level of anxiety and fear than the passive distraction technique. Recommendations: It was recommended that play activities should be applied preoperatively to children undergoing surgeries in hospitals.