Background: Chemotherapy-induced nausea and vomiting (CINV) is one of the most common side effects of chemotherapy in patients. Although sufficient evidence regarding its assessment and treatment in adults exists, CINV is more complicated in children. There are established guidelines for its prevention and treatment endorsed by several reputable organizations; however, their adherence varies between institutions. Therefore, this study aimed to assess the incidence and severity of CINV in pediatric patients receiving any form of chemotherapy in the acute and delayed phases and evaluated our institution’s adherence to published guidelines endorsed by the Pediatric Oncology Group of Ontario. Procedure: This was a prospective longitudinal single-center study. A structured assessment was administered twice to patients or their caregivers during the acute and delayed phases. Baxter Animated Retching Faces scale was used. Results: A total of 186 patients completed 236 surveys, including those for acute and delayed phases. Incidence of acute nausea was reported in 33% patients of both phases, while vomiting was observed in 20.3% and 18.8% of the acute and delayed phases, respectively. A total of 31% patients met the criteria for proper adherence in case of prescribed appropriate antiemetic agent(s)/class irrespective of the dose. Conclusion: CINV is a major side effect among children who receive high and moderate emetogenic chemotherapy compared to those receiving minimal and low regimens. Despite the low rate of adherence to the guidelines, the incidence and severity of CINV reported in our study were acceptable and indicate good clinical practice. Further research should seek strategies to better implement and standardize these guidelines.