Preoperative anxiety in children remains a persistent perioperative problem because it can impair cooperation during anaesthesia induction, increase distress for families, and contribute to postoperative pain, emergence agitation and maladaptive behavioural change. This review compares parental presence during induction with distraction-based strategies, including video games, tablets, audiovisual preparation, virtual reality, therapeutic play, music and tailored cartoon video. A structured literature search was undertaken across major biomedical databases and reference lists for English-language studies published from 2020 to 2025. Priority was given to randomized trials, systematic reviews, network analyses and clinically relevant observational studies involving children undergoing surgery or anaesthesia. Recent evidence suggests that parental presence is valued by many families and may reduce anxiety when parents are calm, prepared and supported, yet its effects are inconsistent when used alone. Distraction techniques show a more consistent anxiolytic signal, especially when active, developmentally matched and continued from holding area to induction. The strongest clinical approach is not a rigid choice between family presence and distraction, but a stepped preventive bundle that screens child and parent anxiety, offers parental preparation, selects a child-centred distraction method, preserves safety, and audits outcomes. The review concludes that distraction should be treated as a core non-pharmacological intervention, while parental presence should be individualized rather than used as a universal policy. Future work should standardize anxiety measurement, compare combined strategies, include parental outcomes, and test feasibility across resource-variable settings.