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Background: Local data on nutritional rickets in Lahore division is lacking, although clinical records indicate its presence and resurgence in this city with seemingly sufficient sunlight. This observational study aims to describe the frequency and predisposing factors of nutritional rickets, particularly in relation to lower respiratory tract infections. Methodology: Out of 170 subjects approached, 71 children were included in the study. Participants were categorized into two groups based on the presence or absence of nutritional rickets. A questionnaire was utilized to collect data on lifestyle, socio-demographics, and eating patterns. Physical examinations were conducted by medical officers, and serum levels of phosphorus, calcium, alkaline phosphatase, and 25-hydroxy vitamin D were assessed. Results: The frequency of nutritional rickets was found to be 29% among patients aged 6 to 59 months. 47.6% of participants with nutritional rickets and 46% of non-rachitic participants were under two years old. Serum phosphorus levels showed an independent association with nutritional rickets. Complexion, breastfeeding, formula feeding, and birth order did not exhibit any statistical association with rickets. Respiratory tract infections were the leading cause of hospitalization (52.3%) among participants with nutritional rickets. A significant correlation was observed between deficiency of the immune modulator 25-hydroxyvitamin D and susceptibility to respiratory tract infections. Conclusion: Rickets remains a prevalent issue in our setting despite abundant sunlight. Pediatricians should proactively examine and screen for rickets in children, especially those showing subtle physical signs. [ABSTRACT FROM AUTHOR]