Introduction: In the Corrientes river basin, Peruvian Amazon, lead exposure among indigenous communities was first reported in 2006. To address controversy regarding the main source of exposure, this study aimed to identify the sources and risk factors for lead exposure among children from the communities in question, and to clarify the potential relationship with oil activity. Methods: This cross-sectional study was conducted in six communities. Participants were children aged 0-17 years and their mothers. Data collection included blood lead levels (BLLs) and hemoglobin determination, a questionnaire on risk factors and environmental sampling. We used age-stratified multivariate regression models, with generalized estimating equation to account for correlation within households. Results: Twenty-seven percent of the children had BLLs ≥10 μg/dl. Mother's BLLs ≥10 μg/dl, playing and chewing lead scraps, fishing ≥three times/week, and living in highly oil-exposed communities increased the risk of having BLLs ≥10 μg/dl. Lead concentrations in sediment, soil, dust, and fish samples were below reference values. Conclusions: Mother's BLLs ≥10 μg/dl, playing and chewing lead scraps to manufacture fishing sinkers were the most important risk factors for children's BLLs ≥10 μg/dl. The connection with oil activity appears to be through access to metal lead from the industry's wastes. © W. S. Maney & Son Ltd 2012.