Just want to add my .02...  I have for a long time been one of those rare
IBCLC's who has in fact recommended pacifier use to certain clients...hear me
out bafore you hang me!

1)  some infants, as previously discussed, do have high sucking needs.  I
find them especially helpful in cases where the baby has nursed well (audible
swallowing, relaxed baby, satiated "milk drunk" pull off etc), is asleep in
moms arms, and as soon as she puts the baby down, or maybe the baby wakes up
10 minutes later, rooting and wanting to suck.  I have found that when all
other indicators of feeding well exist that pacifiers do not impede
breastfeeding.  My own son used his pacifier from birth to 12 weeks, then 20
weeks to 13 months and then gave it up...and a year later he's still nursing!

2)  I  have often found that when moms have said to me "He won't take a
pacifier", that in response to the question, "how do your nipples feel", that
the answer has been - "they hurt".  I have seen- over and over that infants
who "won't" take the pacifier are biters and/or tongue thrusters.

3)  In the above case, in addition to finger training, I have used pacifiers
to suck train infants - some people are not comfortable with finger
training...  This can be done with shorter pacifiers, and I like "the
MINI-MAM".  It is the only one I recommend (Nuk will is ok too...).  Because
it is short and flat, it can only be maintained in the infants mouth if the
tongue extends well, cups and pulls (like at the breast...).  If the suck
pattern is disorganized, or incorrect this type of pacifier will not stay in.
 Unlike the long, bottle looking ones which will stay in with practically any
mouth movement!

4)  Especially in situations where you only get one encounter with mom (i.e.
home health, or bedside nursing) sometimes I feel that it serves us and them
to work with what we have, teach the things that clients/patients will be
most likely to use and or remember.

Several years ago I was at Georgetown's lactation course and I discussed this
with Joanne ? from ILCA (for the life of me I can't remember her last name)
who lectured on Suck.  She suggested I do a study - Who has the Time
though!!!???

Anyway - I know I'm going out on a limb here but this has been my experience
for over 10 years...  I think with regards to just about anything that we
need to look at the "Big" picture and not be positioned about any one
thing...whatever supports women choosing to breastfeed and breastfeed
successfully, heck I'll try it...

Liz Benbrook, RNC, IBCLC
Southern California

P.S.  Please include where you are from when you post - especially in the
US...It helps to compile practice data i.e. I can gleam information on where
cup feeding is being used...or what NICUs will  use banked milk etc.... THANK
YOU!!!!

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