We studied the effect of wearing ear protection on 100 children undergoing cast removal. Pulse rate (PR) and mean arterial pressure (MAP) increases during cast removal were used as physiologic indicators of anxiety. One goal was to determine whether children of various ages are less anxious when wearing ear protection during cast removal. Another goal was to determine whether previous cast removal affects anxiety reactions. Results with children of all ages combined showed that PR increases were significantly lower for those who wore ear protection (P = .04). When wearing ear protection, children up to 6 years old had 9.7% lower PR increases, and 7- to 12-year-olds had 8.8% lower PR increases, but 13- to 17-year-olds had 4.5% higher PR increases. No differences were noted among the groups with respect to MAP increases. There were no significant differences between children who had a cast removed previously and children who were having a cast removed for the first time. Children younger than 13 seemed to benefit the most from wearing ear protection during cast removal.