Effectiveness of oral motor interventions on feeding and orofacial motor outcomes in preterm infants: a systematic review and meta-analysis of randomized controlled trials

Abstract Background Efficient oral feeding is a key functional milestone in neonatal and early childhood care, reflecting neuromuscular maturation, physiological stability, and readiness for hospital discharge. Infants and young children, particularly those born preterm, frequently experience feeding difficulties due to immature oral motor coordination. Structured oral motor interventions have been proposed to enhance feeding-related outcomes; however, their effectiveness remains variably reported. This systematic review and meta-analysis aimed to evaluate the effectiveness of oral motor interventions in improving feeding and oral motor outcomes in infants and young children compared with routine care. Methods A systematic review and meta-analysis were conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. Randomized controlled trials published between 2014 and 2024 were identified through PubMed, Cochrane Library, and Google Scholar. Eligible studies involved infants and young children with feeding difficulties or underdeveloped oral motor function and evaluated structured oral motor interventions compared with routine care or standard feeding support. Study selection was performed using Rayyan. Risk of bias was assessed using the Cochrane Risk of Bias tool version 2.0. Where appropriate, random-effects meta-analyses were performed, and effect estimates were presented as mean differences or standardized mean differences with 95% confidence intervals. The certainty of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach. Results Ten randomized controlled trials were included. All included studies involved preterm infants receiving neonatal clinical care. Oral motor interventions were associated with improvements in feeding readiness, sucking–swallowing coordination, feeding efficiency, and earlier achievement of full oral feeding compared with routine care. Interventions incorporating Premature Infant Oral Motor Intervention demonstrated the most consistent benefits, particularly in reducing the time required to achieve independent oral feeding. The certainty of evidence ranged from low to moderate, with methodological heterogeneity and limited blinding representing the main sources of bias. Conclusions Oral motor interventions were associated with clinically relevant improvements in feeding-related outcomes among preterm infants compared with routine care. Overall, the findings support oral motor interventions as a clinically relevant adjunct to routine care for preterm infants with feeding difficulties associated with underdeveloped oral motor function. However, the certainty of evidence ranged from low to moderate, highlighting the need for further well-designed randomized controlled trials to clarify long-term developmental implications and inform evidence-based clinical practice. Trial registration PROSPERO CRD420251270705.