Background <p>Minimizing pain, fear, and anxiety in children during invasive procedures is crucial for effective communication with both children and their parents, and for facilitating cooperation during medical interventions. Identifying and implementing effective distraction techniques can improve the quality of pediatric care.</p> Methods <p>This randomized controlled clinical trial evaluated the effectiveness of two distraction methods—watching cartoons (passive distraction) and playing video games (active distraction)—on pain, fear, and anxiety levels in children aged 3 to 7 years undergoing invasive procedures. A total of 105 hospitalized children were randomly assigned to one of three groups: control (<i>n</i> = 35), cartoon (<i>n</i> = 35), or video game (<i>n</i> = 35). After obtaining ethical approval, data were collected between 26 November 2019 and 8 January 2020 using a demographic information form, the Oucher Pain Scale, the Children’s State Anxiety Scale, and the Children’s Fear Scale. Data were analyzed using SPSS software, employing chi-squared tests, one-way ANOVA, and repeated measures ANOVA. Additional ANCOVA analyses were conducted to control for baseline differences in pulse and respiratory rate, and effect sizes (partial η²) were calculated for all primary outcomes.</p> Results <p>Children in the control group reported significantly higher levels of pain, fear, and anxiety before, during, and after the procedure compared to those in the cartoon and video game groups (<i>p</i> &lt; 0.001). Both distraction methods were effective, but the video game group consistently showed the lowest scores for pain, fear, and anxiety across all time points (<i>p</i> &lt; 0.01).</p> Conclusions <p>Both cartoon watching and video gaming are effective, low-cost, and practical methods to reduce procedural pain, fear, and anxiety in young children. Video games proved to be more effective.</p> Trial registration <p>The trial registered on ClinicalTrials.gov with numberNCT06826352 on 26/11/2019.</p>