I'm a little behind with my reading, but don't think I've seen any comments
about nipple pain on pumping and flange size.  I find that moms who complain
of the pump hurting often have large or long nipples and that they need a
flange that will pull the nipple in deeper.  We have several of the larger
flangesin our store and I frequently let moms experiment with trying a
flange with a slightly larger opening.  When we get the flange that fits
them best they almost always say that pumping is no longer painful.

In response to-----
>  What I want to know is:  when do you start advising your moms to
> use them, if at all?
 I too start with double pumping and renting a hospital grade pump. I will
ask a mom to come back in 2 or 3 days to do a weight check.  If the baby is
not gaining or is losing wt then we will start a more aggresive approach to
improving moms milk supply.  I agree with not wanting to overwhelm mothers
with too much to do.
Peg Merrill  BS, IBCLC,LLLL(retired), mother of 4
Baltimore, Md.

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