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A sample of 171 children and adolescents aged 3–17 years requiring venepuncture for blood sampling were asked to report on their pain and anxiety and were observed immediately before and during blood drawing. Depending on the measures used, 36–64% of children from 3 to 6 years old experienced moderate to severe distress from blood drawing. Multiple regression analysis revealed that age and the parents' prediction of how upset the child would feel before the blood test was a significant predictor of the observed distress and the self-report of pain. Experience with previous needle procedures did not add significantly to the prediction of distress. Identification of children at high risk to respond poorly to painful medical procedures is discussed.