Environmental lead is a toxic substance that is affecting the growth and development of 3 to 4 million U.S. preschool children today, with effects ranging from learning disabilities to death. This review of environmental lead sources and effects on children provides a background for comprehensive prevention of childhood lead exposure. Prevention strategies at the child, family, and community levels allow for widespread protection of child health and development. Prevention begins with an understanding of the person-environment-occupation framework for the factors that contribute to children at risk for lead exposure. An open system model is presented with specific interventions at the child, family, and community levels, providing innovative, integrated contributions by occupational therapy practitioners for lead exposure prevention and health promotion of children who have been exposed to environmental lead.