Clinical recommendation	Evidence rating	References	Comments
Pacifiers may be used to help relieve pain from minor procedures.	B	4, 12–19	Most studies are small randomized controlled trials.
Pacifiers may be offered at the onset of sleep to reduce the risk of sudden infant death syndrome.	B	6, 22	Reference 22 is a meta-analysis of seven case-controlled studies.
Pacifier use may be associated with early breast weaning or may be a marker of breastfeeding difficulties; therefore, it should be avoided until breastfeeding is well established.	B	5, 7, 21, 23–26	References 21 and 26 are randomized trials.
Although adverse dental effects may occur after 24 months of pacifier use, the effects are more significant after 48 months. Therefore, pacifier use should be discouraged after four years of age.	B	10, 11, 30–32	Reference 30 is a meta-analysis.
Pacifier use should be stopped or limited in the second six months of life to reduce the risk of otitis media.	B	3, 8, 9	Reference 3 is a randomized trial.