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Abstract: Lead poisoning is a preventable environmental disease. Children and developing fetuses are especially vulnerable; even low blood lead levels (BLLs) are linked with learning and behavioral problems. We assessed children''s and their caregivers’ BLLs and risk factors for lead exposure in Chuuk State, Federated States of Micronesia. Children aged 2–6 years were randomly selected within 20 randomly selected villages. Children and caregivers provided venous blood, and caregivers offered information about possible risk factors for lead exposure. Mean BLLs were 39μg/l for children and 16μg/l for caregivers. Children with BLLs of ⩾100μg/l (elevated) were 22.9 (95% CI: 4.5–116.0) times more likely to have a caregiver with an elevated BLL, 6.2 (95% CI: 1.4–27.3) times more likely to live on an outer island, and 3.4 (95% CI: 1.7–6.9) times more likely to have a family member who made lead fishing weights than did other children even after controlling for age and sex. For children, 61% of elevated BLLs could be attributed to making fishing weights. Caregivers with elevated BLLs were 5.9 (95% CI: 1.5–23.7) times more likely to live in a household that melted batteries than other caregivers even after controlling for age and education. For caregivers, 37% of the elevated BLLs could be attributed to melting batteries. The association of elevated BLLs in children and their caregiver suggests a common environmental exposure. Melting batteries to make fishing sinkers is a preventable source of lead exposure for children and their caregivers in Chuuk. [Copyright &y& Elsevier]