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Objective: To evaluate the effectiveness of cryotherapy in managing the pain at the puncture site of Arterio-Venous Fistula (AVF) among children undergoing maintenance hemodialysis (HD).Methods: A one-group pre-post quasi-experiment was performed in two HD centers affiliated with Cairo University.The experiment involved 40 children with AVF undergoing HD.Before puncturing,cryotherapy was applied using 2 cm-3 cm pieces of frozen distilled water in a plastic bag.Pain was assessed subjectively and objectively in two dialysis sessions before and after cryotherapy.A part from a physiological assessment of vital signs,pain was assessed using the Wong-Baker Faces Pain and the Observed Pain Behavior rating scales.All research ethics were applied.Results: HD had a median duration of four years,while cryotherapy had a median application time of 8.8 min.The Wong-Baker Faces Pain score and almost all observed pain behaviors significantly decreased after cryotherapy.Significant improvements were observed in respiratory rate before and after needle puncture and in oxygen saturation after needle puncture.A lower skin dryness was observed after cryotherapy (12.5％) than before cryotherapy (52.5％;p ＜ 0.001).Conclusions: Cryotherapy can effectively reduce the venipuncture pain among children with AVF undergoing maintenance HD.However,the confounding effects of distraction and the non-randomized design used must be both considered when interpreting the findings.This study recommends the use of cryotherapy in managing needle puncture pain.Further research must adopt a randomized trial design with a placebo to support further the benefits of this procedure.