Objective To carry out a diagnosis of children's environmental health and an analysis of risk perception in indigenous communities of the Huasteca Sur region of San Luis Potosí, Mexico, in order to design an intervention strategy in line with their needs. Methods The study used mixed methods research, carried out in two phases. It was conducted in three indigenous communities of Tancanhuitz municipality from January 2005 to June 2006. In the adult population, risk perception was analyzed through focus groups, in-depth interviews, and questionnaires. In the child population, analysis of children's drawings was used to study perception. An assessment of health risks was carried out through biological monitoring and environmental monitoring of water and soil. Results The three communities face critical problems that reveal their vulnerability. When the results were triangulated and integrated, it was found that the principal problems relate to exposure to pathogenic microorganisms in water and soil, exposure to indoor wood smoke, exposure to smoke from the burning of refuse, use of insecticides, exposure to lead from the use of glazed ceramics, and alcoholism. Conclusions To ensure that the intervention strategy is adapted to the target population, it is essential to incorporate risk perception analysis and to promote the participation of community members. The proposed intervention strategy to address the detected problems is based on the principles of risk communication, community participation, and interinstitutional linkage.

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