thickening problems

my baby is 13 wks old today, born at 34 wks. twin brother had reflux but is improved on Prilosec and erythromycin and has relatively big feeds of neosure, 4-5 oz. Elizabeth though, has been on the prilosec, then erythro added, then erythro –> reglan, then neosure–>nutramigen, then thicken w/ rice cereal 1 tbsp / 2oz, then nutramigen –> elecare, still thicken, still on Prilo but reglan stopped. (didn’t seem to help much).

something is weird w/ either formula or cereal…sometimes it takes double the cereal to thicken enough! using dr.brown with y-cut nipple, so if not gravy thick or thicker she chokes. but if thick enough to not choke she falls asleep at half done! intake is much lower now, though still has wet diapers. (tho some are barely wet). before thickening, she was gaining wt, prob bcs of eating so wouldn’t spit up. probly spit up more bcs ovrfeeding. now has much less spitup, still moderate ‘silent reflux’ sx, and i’m sure will not be gaining wt at next visit, even with rice cereal calories. i tried going to just elecare w/o cereal in avent #1nipple, and she choked on that. any recommendations? seems like not thickening was better and just limit the volume (she was doing better pre-thick taking 90-100 cc, down from 125-130, now w/cereal only taking 40-80). but would she get used to the old nipple again? she just shut down and fell asleep when she choked on the old way (avent#1 and no cereal).

sorry for abbrev’s and typos, doing this onefinger peck, holding her w/other arm. (sling i bought scunches her up, but that’s another post…i’ll ask about slings choices later)

thanks