The only "use" for a pacifier is limited to specific strenthening exercises (which could be done with a finger instead) or for coordination, but this would be extremely limited and under the direction of help, not something parents would come up with on their own.
Recognizing many parents will choose to use a pacifier despite risks, I think it is appropriate to discuss pacifier shape and how it influences tongue position and movement.  I think it's also good to tell parents when to avoid pacifier use, such as to space feedings, because they "think" baby is finished, during a growth spurt, when baby is content, as a way of life, etc.  Also, to discontinue pacifier use by 4 months when the baby is awake.  Re: the SIDS recommendation, I also share that if the baby is already breastfeeding to sleep, there is no benefit to using a pacifier during that time as baby is already sucking.  My favorite is a Dr. Sears' pacifier quote, "If you use it, don't abuse it, and quickly try to lose it."  I'd rather parents be informed than avoid the topic altogether.
Amy Peterson, IBCLC
Idaho
coauthor Balancing Breast and Bottle

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