Objectives <p>E-waste recycling releases toxic metals into the environment, posing a considerable threat to children’s health. Since 2012, China has implemented strict regulations and import controls on the e-waste industry. This study investigates the six-year trends of urinary metal levels and health risks in preschool children, including exposure levels, health risks, and association with hemoglobin.</p> Methods <p>A cross-sectional survey was conducted among 762 preschool children in Guiyu, China. We measured levels of 20 urinary metals and hemoglobin levels. To explore the independent and joint associations between metals and hemoglobin, multiple linear regression and Bayesian kernel machine regression models were used.</p> Results <p>Most metals decreased significantly over the period, but some metals remained relatively constant or even increased. Among the metals, lead may be a potential biomarker for e-waste control. The Hazard Index of four metals (nickel, arsenic, cadmium, and lead) exceeded 1 for 98.3% of children. The carcinogenic risk of nickel and arsenic exceeded the threshold for every child and 99.1% of children, respectively. Urinary metal and excretion levels were higher in female. Single metal and mixture metal exposures were significantly correlated with hemoglobin levels and highlight the gender-specific associations.</p> Conclusions <p>Urinary metal levels showed a significant downward trend over time under e-waste control, but the risks from nickel and arsenic remain concerning. Female children face higher risks from metal exposure and elevated hemoglobin levels.</p>