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Background: Disturbance of calcium hemostasis is common in patients of ß-thalassemia major. The objectives of this study were to determine the frequency, distribution and presentation of hypocalcemia in ß-thalassemia major children. Materials and Methods: This cross-sectional study was conducted in Fatimid Foundation Peshawar, Pakistan from to June 2015 to August 2015. 100 patients of ß-thalassemia major, aged 5-20 years were enrolled. After history and examination, serum calcium levels were determined through semi-automated analyzer Microlab 200. Those having levels less than 8.6 mg/dl were labelled as hypocalcemics. Sex, hypocalcemia in ß-thalassemia major, symptomatic hypocalcemia, presence of paresthesias & numbness, myalgias, hyperpigmentation and carpopedal spasm were variables. Frequency and percentage were calculated for all variables. Observed to expected frequencies of all variables were analyzed by chi-square goodness-of-fit test. Results: The frequency of hypocalcemia in ß-thalassemia major was 49/100 (49%), including 25 boys and 24 girls. The frequency of symptomatic hypocalcemia in ß-thalassemia major was 15/49 (30.61%). Paresthesias & numbness was present in 7/49 (14.29%) cases, hyperpigmentation in 6/49 (12.24%), myalgias in 3/49 (6.12%) and carpopedal spasm in 2/49 (4.08%) cases. The frequency of hypocalcemia in ß-thalassemia major and frequency of symptomatic hypocalcemia were higher in our sample than expected for the population. The frequency of paresthesia & numbness and of carpopedal spasm were similar while that of hyperpigmentation and myalgias were lower than expected. Conclusion: Hypocalcemia in ß-thalassemia major is very prevalent and mostly asymptomatic and chronic, therefore calcium levels of such patients should be periodically assessed and calcium supplementation advised where necessary.