Objective To explore the dynamic changes of symptom clusters among children with Acute Lymphoblastic Leukemia (ALL) during chemotherapy. Methods A total of 134 children with ALL were recruited using convenience sampling, who were then investigated using Memorial Symptom Assessment Scale 10-18 (MSAS 10-18) before chemotherapy (T1), induction (T2), consolidation (T3) and maintenance of chemotherapy (T4). Results The top three serious symptoms at each time point were as followed: lack of energy ［2.50(1.00,3.00)］, sweating ［2.00(1.00,2.00)］ and lack of appetite ［1.00(1.00,2.00)］ at T1;lack of energy ［2.50(2.00,3.00)］, sweating ［2.00(2.00,2.00)］ and hair loss ［2.00(2.00,2.00)］ at T2; hair loss ［3.00(2.00,4.00)］, "I don′t look like myself" ［2.50(2.00,3.00)］ and sweating ［2.00(1.00,2.00)］ at T3; hair loss ［2.00(0.00,2.00)］, "I don′t look like myself" ［2.00(0.00,2.00)］ and skin changes ［1.50(0.00,2.00)］ at T4. There were 3 symptom clusters (emotional, gastrointestinal, and somatic) at T1, 6 (gastrointestinal, emotional, somatic, nervous system, self-image damage,skin mucosal) at T2 and T3, and 5 (emotional, gastrointestinal, somatic, nervous system, self-image damage) at T4. Conclusion The incidence and severity of symptoms among children with ALL during chemotherapy are high, the symptoms at different time points can be aggregated into clusters, and the symptom clusters are stable and dynamic. Medical staff should dynamically assess and manage the symptoms of children according to the trend of symptom clusters at each stage.