Blood lead level determinations were carried out on 100 children seen at an outpatient clinic for developmental and learning disabilities in a rural Southern state. One child with moderately elevated blood lead and nine with minimally elevated blood lead were identified; 7 of these 10 children were microcephalic, a markedly and significantly higher rate of microcephaly than in the remainder of the clinic sample. Most of the children suffering from the lead-microcephaly syndrome were Black, and a majority had birth weights under 2500 g, suggesting the possibility that prenatal exposure to lead might have caused their microcephaly and developmental handicaps.