“Iron deficiency is the most common and widespread nutritional disorder in the world. As well as affecting a large number of children and women
in non-industrialized countries, it is the only nutrient deficiency which is also significantly prevalent in virtually all industrialized nations. It can be estimated that most preschool children and pregnant women in non-industrialized countries, and at least 30-40% in industrialized countries, are iron deficient (21, 51).” 
In 1990-5 it was estimated that 20% of children in industrialised countries aged 0 – 4 yrs were anaemic. 
In addition, long term PPI use has been associated with problems with iron absorption. 
Add to that the feed refusing habits of many of our refluxing picky eaters (in particular in relation to protein) and there’s a more than average likelihood that our reflux children can be suffering from iron deficiency.
Here are the symptoms (remember, as with all symptoms, not all need to be present for you to raise it with your medical professional):
- Blue-tinged or very pale whites of eyes
- Blood in the stools
- Brittle nails
- Decreased appetite (especially in children)
- Pale skin color (pallor)
- Shortness of breath
- Sore tongue
- Unusual food cravings (called pica)
Note: There may be no symptoms if anemia is mild. (Symptom list from Mediline Plus article listed below. Full article here.)
What to do
See your General Practitioner if you child exhibits some of these symptoms and you suspect iron might be an issue. It will usually require a blood test to determine the child’s iron levels but a GP will have a good idea of whether there are enough indications for the test to be required.
A medical professional will usually encourage you to help the child eat foods that are higher in iron but may also choose to prescribe an iron supplement. It is likely that supplements will reverse the effects within 2 months but that supplements may be required to be taken for 6 to 12 months. 
Iron supplements can be constipating so mention this to your medical professional at the time if your child also has a history of motility issues.
Iron requirements and sources
“Babies are born with iron stored in their bodies. Because they grow rapidly, infants and children need to absorb an average of 1 mg of iron per day.
Since children only absorb about 10% of the iron they eat, most children need to receive 8-10 mg of iron per day. Breastfed babies need less, because iron is absorbed 3 times better when it is in breast milk.
Cow’s milk is a common cause of iron deficiency. It contains less iron than many other foods and also makes it more difficult for the body to absorb iron from other foods. Cow’s milk also can cause the intestines to lose small amounts of blood.” 
Authored by Joanne Matthews, July 2013
Last updated July 2013
1. World Health Organisation in association with United Nations Childrens Fund and United Nations University: Iron Deficiency Anaemia: Assessment, Prevention, and Control. A guide for programme managers, 2001. pg 31
2. Tetsuhide Ito & Robert T. Jensen; Association of Long-Term Proton Pump Inhibitor Therapy with Bone Fractures and Effects on Absorption of Calcium, Vitamin B12, Iron, and Magnesium; Current Gastroenterology Reports; December 2010, Volume 12, Issue 6, pp 448-457
3. Yi-Bin Chen, MD, & reviewed by David Zieve, MD, MHA; Iron deficiency anemia – children; Mediline Plus, Page version last updated: 22 March 2013