Children with severely atypical development often display pica, habitual mouthing, and odd food preferences as symptoms from the first year of life. Such children can ingest dangerous amounts of lead even in environments that are usually considered safe. Mean blood lead concentration was notably higher in 18 autistic children than in 16 nonautistic psychotic children or in ten normal siblings. Fifteen (44%) of the psychotic children (autistic and nonautistic) had blood lead levels greater than two standard deviations above the mean for normal controls. Behavioral and neurological sequelae of elevated blood lead level may be obscured in severely disorganized children. Screening for blood lead should be part of the medical care of these vulnerable children with pica.