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Objective This study examined whether increasing the demand for central cognitive processing involved in a distraction task, by involving the child in ongoing, effortful interaction with the distraction stimulus, would increase children's tolerance for cold pressor pain. Methods Seventy-nine children ages 6–15 years underwent a baseline cold pressor trial followed by two cold pressor trials in which they received interactive distraction (i.e., used voice commands to play a videogame) or passive distraction (in which they merely watched the output from the same videogame segment) in counterbalanced order. Both distraction conditions were presented via a virtual reality-type helmet. Results As expected, children demonstrated significant improvement in pain tolerance during distraction relative to baseline. Children showed the greatest improvement during the interactive distraction task. Conclusion The effects of distraction on children's cold pressor pain tolerance are significantly enhanced when the distraction task also includes greater demands for central cognitive processing.