Pain is one of the worst experiences of pediatric patients due to various medical interventions, often contributing to pain and distress. Pain awareness is influenced by the child's age, cognitive level, communication skills, and previous pain experiences. Phlebotomy and vascular puncture are the most common invasive measures used for children. Distraction is one of the non-pharmacologic methods with the greatest level of evidence used to diminish pain following invasive procedures in children. Vibrating cold and stress balls are cognitive distraction methods. Aim: evaluate the effect of vibrating cold application versus stress ball distraction on children's physiological parameters, pain, and stress during Phlebotomy. Subjects & Setting Randomized Sampling of 75 children from Pediatric Medical and Hematology departments at Tanta Main University Hospital. Tools: Tool I: Children's bio-social characteristics and their physiological parameters, Tool II: Wong-Baker Faces Pain Rating Scale & Tool III: Children's behavioral distress observational checklist. Results: total mean scores of Wong-Baker Faces Pain Rating Scale & behavioral distress were lower among children in vibrating cold application compared to the other two groups. Conclusion: vibrating cold application and stress ball are effective in reducing pain and behavioral distress during phlebotomy. Recommendation: Educational programs should be conducted for pediatric nurses regarding the use of vibrating cold and stress balls during phlebotomy.