Pica for lead-containing paint has been questioned as the principal mechanism for the widespread moderately elevated blood lead levels (30 to 80 microgram/100 ml) in inner city children. This study explored the hypothesis that lead-contaminated household dust is a major source of lead for these children; hand contamination and repetitive mouthing is the proposed mechanism of ingestion. Forty-nine inner city children with blood lead 40 to 70 microgram/100 ml were matched with 50 children with blood lead less than or equal to 29 microgram/100 ml from the same inner city environment. House dust lead and lead on hands were found in significantly greater quantity among experimental subjects. Other factors differed between groups; lead content of peeling paint, soil lead, and pica affected more experimental than control children, but did not account for more than 50% of experimental cases. The cause of moderate blood lead elevation is multifactoral: no single source accounted for all children with elevated levels. However, lead contamination of house dust and hands appears to be a major factor in this condition.