Objective: Vomiting is a common and distressing acute side effect of chemotherapy, negatively impacting quality of life, nutritional status and the ability of patients to tolerate further treatment. Standardized guidelines have been developed for anti-emetic regimens to improve control of nausea and vomiting. We aimed to determine the benefit of adherence to clinical practice guidelines (CPGs) on complete control of vomiting during chemotherapy in newly diagnosed pediatric patients with cancer. Methods: An electronic dashboard of pediatric patients newly diagnosed with cancer at Phoenix Children’s Hospital between August 2019 and January 2021 and receiving their first cycle of chemotherapy was utilized to monitor chemotherapy regimen, anti-emetic medications and vomiting episodes. Blocks were classified as guideline inconsistent, guideline-consistent, or guideline-consistent PLUS if additional prophylactic anti-emetic medications were utilized. We identified patients with complete control of vomiting, defined as no vomiting and no additional anti-emetics needed. Results: Among 136 patients, 29% received guideline inconsistent care, 37% received guideline-consistent care, and 34% received guideline-consistent PLUS care. 48% achieved complete control of vomiting. Older patients (p<0.0001) and higher emetogenicity chemotherapy (p=0.0003) were more likely to receive guideline-consistent or guideline-consistent PLUS therapy. With guideline-consistent and consistent-PLUS grouped together, diagnosis also was associated with improved adherence to CPGs (p=0.022). Multivariate analysis showed that patients more likely to receive guideline-consistent care were of older age (OR 1.11, p=0.016) and solid tumor patients (OR 5.59, p=0.028). Conclusions: Despite high rates of CPG adherence, complete control of vomiting remains sub-optimal which highlights the need for novel and/or risk-adapted therapies.