If you're nursing and you've had trouble getting a breastfeeding routine going, your baby may not be getting enough to eat. If you're feeding your baby formula, preparing the formula incorrectly can lead to failure to gain weight. It can also affect bottle feeding, though that's less common. Being tongue-tied could make it difficult for your baby to nurse well and get all the nourishment she needs. (A cleft lip and palate are usually repaired over the course of a baby's first year.) These conditions are addressed with special bottles and nipples and the help of feeding specialists. A cleft lip or palate would interfere with breastfeeding. She may have a weak sucking reflex that leaves her unable to get enough milk from your breasts if you're nursing – or even from a bottle, although this occurs more commonly with breastfeeding. Your baby may be repeatedly getting tired and falling asleep before he gets enough milk. In general, if your baby isn't growing steadily, it means that she's either not eating well or not absorbing or using nutrients properly. 
There are so many potential causes that a doctor could spend months performing tests and studying a baby's diet, health history, activity level, and possible causes of stress before discovering the source of the problem.
What could be causing my baby's failure to gain weight? It can be difficult to hear that your baby isn't thriving, but it's important that you don't blame yourself or feel like you're not a good or nurturing parent. This can be a worrisome and frustrating time. The doctor may refer your baby to a pediatric gastroenterologist, a dietitian, or a feeding specialist for evaluation and treatment. Sometimes the answer is very simple, and sometimes it's quite complicated. She may also watch you nurse or bottle-feed to see whether your baby's jaw is working correctly or whether he's having trouble sucking. Your baby's doctor may order blood, urine, or other tests and monitor your baby's caloric intake for a period of time.
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