Pacifier use in the first month of life.

QUESTION As a family physician who frequently attends deliveries and follows up with neonates, parents often ask me if they can provide their newborns with pacifiers in order to calm infants down, reduce crying, and improve sleep. Is pacifier use safe in the first month of life? ANSWER While pacifiers are useful for soothing, there is concern that their use might cause early weaning of breastfeeding owing to "nipple confusion." Several organizations, such as the World Health Organization and the United Nations Children's Fund, recommend avoiding use of pacifiers in term infants who breastfeed. However, evidence suggests that it might not be pacifier use that causes premature cessation of breastfeeding, and that use of pacifiers might only be a sign of a maternal decision to stop breastfeeding.