In Reply .— We thank Dr Merritt and his colleagues for their original publications about a case of childhood lead poisoning associated with the ingestion of a lead-contaminated toy necklace1,2 and Dr Merritt for the letter above. He disagrees with our assessment that this child had chronic lead exposure rather than simply 1 “acute” exposure from the swallowed medallion and offer the fact that a thorough environmental investigation failed to uncover a source of lead exposure as evidence that this child's problem was caused exclusively by this ingestion. They also point in their letter to their ongoing neurocognitive surveillance of this youngster rather than offer input on our suggestion that this …