The effect of pharmacological acid suppression on iron status in infants remains uncertain. Although reduced gastric acidity may impair non-heme iron absorption, evidence is insufficient to establish the prevalence of iron deficiency anemia among infants receiving proton pump inhibitors or histamine-2 receptor antagonists. Reliance on hemoglobin without assessing iron stores, underrepresentation of certain drug classes, and inadequate control of nutritional factors limit interpretation. The absence of a statistically significant increase in anemia does not exclude iron deficiency. Distinguishing treatment effects from disease-related mucosal injury and feeding difficulties further complicates assessment. This letter emphasizes the distinction between iron deficiency and iron deficiency anemia, cautions against extrapolating adult findings to infants, and supports indication-based prescribing. Prospective studies incorporating baseline and follow-up assessments of iron status, detailed drug exposure and dietary data, and adjustment for disease severity are needed. Meanwhile, clinical decisions should balance treatment benefits against uncertainty regarding nutritional outcomes.