This chapter reviews the impact of lead exposure in the context of a case, highlighting pathophysiology, neurodevelopment, psychosocial considerations, and health disparities. Despite primary and secondary prevention efforts, lead exposure remains an important pediatric environmental health problem. Lead influences brain development and function through multiple mechanisms, primarily involving displacement of calcium and zinc in several cellular processes involved in neuronal growth, differentiation, development, and communication. Outcomes at low levels are idiosyncratic and span a variety of neurocognitive domains. Consequently, a standardized and comprehensive approach to evaluation and tailored approach to intervention are essential to maximizing outcomes and reducing disparities for affected youth. Ongoing efforts to reduce disparities in who is lead exposed, prevent lead exposure altogether, and enhance lead-mitigating strategies once lead exposure has occurred are critical.