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The next Live PIOMI Training Webinar is
June 22 2024  or  August 10 2024
9am-12 Central (Chicago)Time

Now offering 3.0 CEUs!! (Nursing)  
Register by clicking on Webinars above and RSVP.


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'"PIOMI has been the centerpiece in
my care plan for preparing premature infants for future oral feedings. I waited until the research was definitive, but now I feel confident that I am using a solid evidence-based practice with these tiny, fragile babies. PIOMI has given me a greater sense of purpose when I treat and has inspired me to invest more time in preparing the sensory-motor system for complex feeding skills!"


MARCH 2022

"I am a speech therapist living and working in Italy. I have been dealing with oral-motor problems and swallowing problems for more than 25 years. For more than 20 years I have worked within the ENT department at San Raffaele Hospital in Milan. Here I have the opportunity to collaborate with several departments including the NICU. I took the PIOMI certification directly with Dr. Brenda Lessen Knoll, and this year we were able to organize the PIOMI certification course for all NICU staff at San Raffaele Hospital. On this occasion Dr. Lessen Knoll gave me the trainer certification. Thank you Brenda for your professionalism and willingness not only to teach but also to engage with all of us. Thank you also, for your pioneering work that is now scientifically supported by more than 60 studies!  I am sure that now new ways and new projects will open up for us to work together again.


San Raffaele Hospital, Milan, Italy


What is PIOMI?

Premature Infant Oral Motor Intervention (PIOMI) is a 5-minute oral motor intervention using a pinky finger in the and around the mouth of preterm infants as young as 29 weeks PMA. PIOMI aims to mimic the in-utero oral experience that strengthens and develops feeding mechanisms. The 8 steps provide assisted movement to activate muscle contraction and provide movement against resistance to build strength in areas needed for subsequent bottle and breastfeeding. The intervention increases functional response to pressure and improves control of movements for the lips, cheeks, jaw, and tongue.

Evidence demonstrates that preterm infants who are offered PIOMI will have:

  • Earlier readiness to feed

  • Reduced transition time to full oral feedings

  • Decreased length of hospital stay 

  • Increased mean Neonatal Oro-Motor Assessment Scale score

  • Improved Early Feeding Skills (EFS) Assessment

  • Improved Preterm Oral Feeding Readiness Assessment Scale (PTOFRAS)

  • Improved LATCH score

  • Increased direct breastfeeding rates at 1 month and 3 months after discharge from the NICU

  • Improved scores on neurological battery at 3 and 6 month follow up

Excerpt from Training Video 



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The PIOMI has become BEST PRACTICE for early oral motor therapy. It has been the focus of  many randomized controlled trials in the USA and internationally. PIOMI evidence has been included in several systematic reviews (Cochrane) and meta-analyses. Evidence is consistently strong for earlier readiness to feed, faster transition to full feeds, and shorter length of stays.

See list of all PIOMI Studies and Presentations here:


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Join leading hospitals and NICU teams who have completed on-site training to implement PIOMI as their oral motor standard of care.  

Dr. Knoll trains RNs, MDs, NNPs, OT, PT,  SLPs, and Parents to implement PIOMI in your NICU.

PIOMI is used at Cleveland Clinic, CHOP, Boston Children's, and more.



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Since the initial publication of the PIOMI in 2011, staff in more than 100

NICUs in over 30 countries have been formally trained to implement PIOMI in their NICU or Clinic.

To bring the PIOMI to your NICU, contact Dr. Brenda Lessen Knoll.

"I am an Italian speech therapist and a pediatric nurse. I read about PIOMI and contacted Dr. Brenda Lessen. I had the pleasure to meet her in Chicago where I received personalized training and certification to use PIOMI and also to be a trainer. I was then able to use this tool within my NICU at Giannina Gaslini Hospital in Genoa, with excellent results both from a clinical and research point of view.


Thanks to my certification as a trainer, we organized the first course on preterm infant oral feeding with PIOMI training in Bologna, Italy in January 2020 with excellent results and great interest. I sincerely thank Brenda for her amazing work and training me on PIOMI, for her kindness and professionalism, and for the work we are doing together! I look forward to continuing our work together!"

Marta Majoli, SLP


Speech and Language Pathologist

Giannina Gaslini Hospital Genoa, Italy



Brenda Lessen Knoll, PhD, RN 


1312 Park St. • Bloomington, IL 61701  Tel: 309-212-0544

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