What is PIOMI?

Premature Infant Oral Motor Intervention (PIOMI) is a 5-minute oral motor intervention that provides assisted movement to activate muscle contraction and provides movement against resistance to build strength in premature infants. The intervention increases functional response to pressure and control of movements for the lips, cheeks, jaw, and tongue.

Researchers found that use of the PIOMI resulted in:

  • 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

Excerpt from Training Video Below.


PIOMI intro clip



The PIOMI has been the focus of multiple randomized controlled trials in the US and internationally. PIOMI evidence has been included in multiple systematic reviews (Cochrane) and meta-analyses.

Review or share your PIOMI study with us here.



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



Since the initial publication of the PIOMI in 2011, staff in more than 55

NICUs in 16 countries have been formally trained to implement the program.

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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© 2020 by Brenda Lessen Knoll