PURPOSE: Needle procedures, like venipuncture and intravenous (IV) catheter insertion, are recognized as a common cause of pain and fear for children in hospitals and emergency departments. The purpose of this study was to compare children's self-reported pain and fear related to IV insertion with administration of either the topical local anesthetic EMLA(R) or 1% buffered lidocaine delivered with the J-Tip Needleless Injection System(R) (J-Tip(R)). DESIGN AND METHODS: In this prospective, randomized trial, 150 consecutive pediatric patients 8 to 18years of age undergoing IV insertion were randomly assigned 1:1 to treatment group. Participants self-reported procedural pain using a Visual Analog Scale, and procedural fear using the Children's Fear Scale. RESULTS: Procedural pain scores were significantly lower in the EMLA(R) group (mean score 1.63+1.659) vs. the J-Tip(R) group (2.99+/-2.586; p<0.001). Post-procedure fear scores were significantly lower than pre-procedure fear scores in both treatment groups (p<0.002), but there was no difference in fear scores between the two treatment groups (p=0.314). CONCLUSION: EMLA(R) provided superior pain relief for IV insertion compared to J-Tip(R). PRACTICE IMPLICATIONS: Although EMLA(R) use resulted in lower self-reported pain scores compared to J-Tip(R), pain scores for both treatments were low and fear scores did not differ. When IV insertion can be delayed for 60-90min, EMLA(R) should be used. When a delay is contraindicated, J-Tip(R) may be a reasonable alternative to minimize procedural pain of IV insertion.