The associations of the Bsm1 polymorphism of vitamin D receptor gene and blood lead, zinc protoporphyrin and physical development in 476 environmental lead-exposed children were studied. After blood lead level, age, sex and education level of the patients were adjusted by analysis of covariance, the children with B allele had larger head circumference than those with bb genotype(P = 0.02). While the subjects were stratified by blood lead level and sex, the statistically significant difference in head circumference between different Bsm1 genotypes was found only in high-blood-lead subgroup and in male subgroup. No significant influence of Bsm1 polymorphism on blood lead level, zinc protoporphyrin, height and weight was found, suggesting that the Bsm1 polymorphism of VDR gene may modify the effect of lead on the skull development of children highly exposed to lead.