Health issues due to chronic exposure to environmental pollutants pose an increasing global challenge. Accurate risk assessment of environmental hazards requires advanced methodologies alongside analytical skills. Recent studies emphasize the need for area-specific health risk assessments for different population groups, particularly regarding children’s susceptibility to heavy metal exposure. This study evaluates cumulative health risks in children in Tuzla Canton, Bosnia and Herzegovina, by assessing the exposure to lead (Pb), cadmium (Cd), and arsenic (As) through soil, water, air, and food using an integrative and aggregative approach. The integrative health risk assessment suggests an increased health risk for children from heavy metal exposure through air (HI = 58.52), while no increased risk was observed through other environmental compartments. An exception appeared when Monte Carlo simulations provided a probabilistic analysis, outperforming conventional deterministic techniques. Results indicated that 28.9% of the child population also faced increased health risks due to Pb exposure from water consumption. This probabilistic approach enables a pragmatic evaluation of potential health risks under specific exposure conditions, offering critical insights into possible health impacts. The aggregative technique, assessing risks posed by single metals across multiple exposure routes and compartments, identified Cd as a more significant health concern among the three other metals (Cd > As > Pb). Both approaches, combined with sophisticated probabilistic techniques, are required for evaluating the effects of hazardous mixtures, where co-exposures may result in synergistic or additive outcomes. The findings provide useful information for developing public health measures to reduce exposure and highlight the benefit of Monte Carlo simulations in the health risk assessment process.