Background: It is estimated that the prevalence of malnutrition in children with cancer may be as high as 50%. Optimization of nutritional status is known to be associated with improved tolerance of cancer therapy, decreased infection risk, increased quality of life and increased survival. There are established methods for improving nutrition, but we have observed barriers to the identification of at risk patients, adherence to recommended interventions and continued surveillance. Methods: We identified patients in the intensive phases of therapy for acute lymphoblastic leukemia/lymphoblastic lymphoma. Using improvement science methods, we developed a standardized approach to the identification, treatment and tracking of patients at risk for malnutrition. We utilized quality improvement techniques to identify the problems with the current system and implement change. These changes included standardization of an algorithm for nutritional treatment and follow up, creation of a daily electronic report for identification of at risk patients, and improved communication with providers in regard to patient nutrition. Results: At baseline, nearly 10% of our target patients were impacted by significant weight loss. Utilizing quality improvement techniques, we were able to establish the most common causes of failure in our system (awareness of the problem, identification of at-risk patients, tracking and monitoring at-risk patients and provider/patient adherence to recommended nutritional interventions). Interventions were employed using plan-do-study-act quality improvement methods, including the development of an electronic identification and tracking system designed for these patients. We were able to significantly decrease the number of patients with weight loss using these methods. Conclusions: Malnutrition is associated with poor outcomes in patients with cancer. Use of quality improvement methods allowed us to identify key drivers and test/implement specific interventions to combat this problem. In this proof of principle cohort, this has resulted in a significant improvement in the nutritional status of our patients.