This study aimed to elucidate the complex interactions among cognitive, emotional, sleep, and fatigue symptoms in children with malignant solid tumors using a network analysis approach. A total of 230 pediatric patients (aged 6–18 years) were recruited from a tertiary hospital in Chongqing. Symptom data were collected using the Wechsler Intelligence Scale for Children- Fourth Edition (WISC-IV) Chinese version (short form), the Generalized Anxiety Disorder-7 (GAD- 7), the Patient Health Questionnaire-9 (PHQ-9), the Sleep Disturbance Scale for Children (SDSC), and the PedsQL Multidimensional Fatigue Scale (PedsQL MFS). A Gaussian Graphical Model was employed to estimate the symptom network, calculate centrality indices, and perform subgroup comparisons. Results showed a high prevalence of symptoms: Cognitive impairment (44.78%), anxiety (51.74%), depression (29.13%), and sleep disturbances (63.48%). Network analysis revealed that S5-DOES (“Disorders of Excessive Somnolence”), S1- DIMS (“Disorders of Initiating and MaintainingSleep”), and F3-CF (“Cognitive Fatigue”) were the most central nodes across the sample. Notably , F3-CF (“Cognitive Fatigue”) emerged as the primary bridge symptom connecting different symptom domains. Network comparison tests further identified significant differences in global strength and structure between clinical subgroups. In conclusion, cognitive, emotional, sleep, and fatigue symptoms are highly interconnected in pediatric oncology . Our findings suggest that S5-DOES (“Disorders of Excessive Somnolence”) and F3-CF (“Cognitive Fatigue”) are critical intervention targets. Tailored clinical strategies based on tumor type andcognitive status are warranted to achieve synergistic symptom management and improve overall patient outcomes.