The first thousand days of a child's life, from conception to their second birthday, represent a critical window for growth and development (Likhar & Patil, 2022). During this period, adequate nutrition ensures optimal development of the physical, cognitive, and immune systest (Shao et al., 2021; Nurprastiwi et al., 2024). Malnutrition during these formative years can lead to irreversible consequences, including stunted growth, cognitive impairments, and reduced productivity in adulthood (Soliman et al., 2021). In Indonesia, where stunting and micronutrient deficiencies remain persistent public health challenges, addressing nutritional gaps in early childhood is urgent to safeguard the nation’s future (Yusriadi et al., 2024; Ariskawati et al., 2024).

Poor dietary intake and recurrent illnesses in toddlers often disrupt nutrient absorption, weakening immunity and increasing susceptibility to infections (Morales & Leon, 2023). Chronic malnutrition during this vulnerable phase can result in stunting, a condition marked by impaired growth and developmental delays (Kiani et al., 2022). Stunting affects individual potential and poses long-term socioeconomic burdens, limiting educational attainment and workforce productivity. With toddlers being the cornerstone of a nation's future, ensuring their health through targeted nutritional interventions is imperative (Akseer et al., 2022; Shofa et al., 2024).

Feeding difficulties, particularly in children aged 1–3 years, exacerbate the risk of malnutrition (Boctor et al., 2021). This phase, often termed the food jag period, is characterized by selective eating habits or outright refusal of nutritious foods. While pharmacological approaches like multivitamin supplements are commonly used, non-pharmacological strategies, including herbal remedies, creative meal preparation, and traditional therapies, are gaining traction as sustainable, community-friendly solutions (Goyal & Chauhan, 2024).

Among these non-pharmacological methods, Tui Na massage has emerged as a promising complementary therapy. Rooted in traditional Chinese medicine, Tui Na is a needle-free adaptation of acupuncture focusing on stimulating acupoints to enhance digestive function and appetite (Sadiya et al., 2023). This gentle massage technique aims to optimize nutrient absorption and metabolic processes by improving blood circulation in the spleen and gastrointestinal tract, addressing physiological and behavioral feeding difficulties (Singh et al., 2024).

The nutritional components of locally available foods further complement such therapies (Oladiran et al., 2020; Ismarina et al., 2024). Broccoli, carrots, and chicken, staples in many Indonesian households, offer a rich blend of vitamins, minerals, and proteins. Broccoli provides fiber, calcium, and vitamins A, C, and K, supporting immune and digestive health (Syed et al., 2023). Carrots, abundant in beta-carotene and antioxidants, promote vision and cellular protection. Chicken, a high-quality protein source, supplies essential amino acids for muscle and brain development. Together, these foods form a holistic dietary foundation to combat malnutrition (Klevina et al., 2023).

Tui Na massage enhances the efficacy of these nutrients by stimulating the release of epinephrine and norepinephrine, hormones that regulate metabolism and appetite (Tiwery, 2024). Regular massage sessions have been linked to increased feeding frequency, improved motor function, and structural growth in toddlers. By harmonizing physiological processes and dietary intake, this approach addresses the multifaceted nature of malnutrition (Chen et al., 2024).

Community-based interventions like "GEBYAR CERIA PINAM" integrate Tui Na massage with nutritional education and locally sourced meals. This initiative empowers caregivers with practical skills to prepare nutrient-dense foods while incorporating traditional therapies to stimulate appetite. The program fosters sustainable improvements in child health outcomes by combining modern nutritional science with culturally resonant practices (Sadiya et al., 2023).

Preliminary evidence suggests that Tui Na massage improves lymphatic and blood circulation, aiding digestion and weight gain in undernourished toddlers. Enhanced nutrient absorption and increased appetite position this therapy as a viable adjunct to conventional treatments. Such low-cost, non-invasive methods are particularly valuable in resource-limited settings, where access to healthcare services may be constrained (Anggraeni et al., 2022).

The objective of this community service activity is to improve mothers’ knowledge and skills in managing feeding difficulties among toddlers through the implementation of complementary therapy and nutritional education. GEBYAR CERIA PINAM represents a holistic, community-driven strategy to tackle malnutrition and stunting in Indonesia. By merging the physiological benefits of Tui Na massage with nutrient-rich diets, the program addresses the symptoms and root causes of feeding difficulties. Empowering families with accessible tools to nurture healthy toddlers strengthens individual futures and lays the groundwork for a healthier, more resilient generation (Skouteris et al., 2022). This initiative underscores the transformative potential of integrating traditional wisdom with evidence-based practices in public health.

This Community Service uses counseling and demonstration methods to implement non-pharmacological management, including complementary therapies, to address children's appetite issues. This Community Service is carried out in collaboration with TPMB Bdn. Rini M. Harianto, S.Tr.Keb, Mrs. RW 02, and cadre mothers, attended by supervisors, mothers with toddlers aged 24 – 60 months as participants. Before implementing community service, several preparations are carried out. First, a Focus Group Discussion (FGD) will be conducted to determine problem priorities. The Focus Group Discussion was also attended by Midwife Rini M. Harianto from the Independent Practicing Midwife, supervisor, Mrs. RW 02, and Mrs. Nusa Indah, a Posyandu cadre. Based on the focus group discussion results, the priority problem at Posyandu Nusa Indah is weight loss/maintenance among toddlers aged 24-60 months due to poor appetite.

After obtaining the priority problems, preparations for implementing community service are carried out. Counseling materials, demonstration steps on creating healthy snacks, Tui na massage to increase appetite, preparing questions to evaluate participants' knowledge, and giving rewards to participants who can answer questions. This community service initiative, "GEBYAR CERIA PINAM," has received ethical approval from the Faculty of Health Science, Universitas Nasional, ensuring compliance with national and international ethical standards for human research. The approval underscores the program’s commitment to safeguarding the rights, safety, and well-being of participating toddlers and their families throughout the intervention. By adhering to rigorous ethical guidelines, the project aims to deliver holistic, culturally sensitive, and sustainable solutions to address malnutrition while respecting community values and health priorities.

Table 1 shows that the community service activity involved 22 participants from different stakeholder groups, including mothers with toddlers, midwives, community health cadres, and academic supervisors. Most participants were mothers with toddlers, the main target group for the intervention, while health professionals and academic supervisors played supporting roles in facilitating knowledge transfer and practical training. The involvement of multiple stakeholders indicates a collaborative approach to improving toddler nutrition management and promoting the implementation of complementary therapy within the community setting. The session focused on educating caregivers about feeding difficulties in toddlers, particularly during the food-jags phase, and on introducing complementary therapies, such as Tui Na massage, to address appetite and digestive issues. The interactive format combined theoretical explanations, practical demonstrations, and participatory discussions, fostering a collaborative learning environment (Laksono & Nursitiyaroh, 2023).

See Table 1 for the detailed data presented below.

Table 2 demonstrates that the “GEBYAR CERIA PINAM” program successfully improved participants’ understanding and practical skills related to toddler feeding difficulties and complementary care. The educational session, interactive discussion, and hands-on demonstration helped participants recognize appropriate nutritional management strategies and apply Tui Na massage techniques. Although only five participants achieved perfect scores in the post-session quiz and one mother successfully demonstrated the massage technique, the activity provided participants with practical resources, including educational leaflets and healthy snack guidelines, to support continued practice at home.

See Table 2 for the detailed data presented below.

During the educational session, participants were briefed on the physiological and behavioral factors contributing to feeding difficulties, with an emphasis on nutrient absorption and metabolic health. The Tui Na massage technique was demonstrated as a non-invasive method for stimulating digestive function and improving appetite (Ha et al., 2025). Key acupressure points and massage sequences targeting the spleen and gastrointestinal tract were taught, aligning with traditional Chinese medicine principles. The hands-on demonstration allowed participants to practice the technique under supervision, ensuring clarity and confidence in its application (Dai et al., 2023).

A post-session quiz was administered to assess knowledge retention, with participants answering questions on feeding challenges and Tui Na massage protocols. Five of the 22 attendees answered all questions correctly, and one mother successfully demonstrated the massage technique on a toddler dummy. Correct answers were rewarded with prizes to incentivize engagement. This approach reinforced learning and highlighted the participants' ability to apply theoretical knowledge practically. The quiz results indicated a moderate understanding of the material, suggesting that targeted follow-ups could further enhance comprehension.

Educational leaflets were distributed to all participants, containing illustrated guides to Tui Na massage steps and recipes for nutrient-dense snacks using locally available ingredients such as broccoli, carrots, and chicken. These resources were designed to serve as quick references for caregivers, ensuring continuity of practice at home. Feedback from participants indicated that the visual aids were user-friendly and culturally adaptable, addressing potential barriers to implementation. The integration of traditional therapies with modern nutritional science was well-received, reflecting the community’s openness to holistic health approaches.

Post-intervention discussions revealed that participants felt more empowered to address feeding difficulties through non-pharmacological methods. Mothers expressed enthusiasm for incorporating Tui Na massage into their daily routines, citing its simplicity and perceived benefits for their children’s digestion (Chen et al., 2025). Community health cadres emphasized the program’s alignment with local health priorities, particularly in reducing stunting rates. However, some participants requested additional training to refine their massage techniques, underscoring the need for sustained mentorship.

Despite the program’s success, challenges such as time constraints for hands-on practice and varying literacy levels among caregivers were noted. Future iterations could include smaller group sessions for personalized guidance and multimedia resources to accommodate diverse learning preferences. Collaborations with local midwives and cadres will be critical to ensuring the long-term adoption of the practices.

GEBYAR CERIA PINAM demonstrated the feasibility of integrating traditional therapies and nutritional education to address feeding difficulties in toddlers. The active participation of caregivers and healthcare providers highlighted the community's readiness to adopt innovative, low-cost interventions. By combining ethical rigor, culturally resonant practices, and practical resources, the program is a model for scalable community health initiatives to improve child nutrition and development outcomes.

The community service implementation went well and was attended by all invited parties. Participants can receive all the materials and ask questions during the question-and-answer session. Participants can also demonstrate the complementary care "GEBYAR CERIA PINAM" to overcome the lack of appetite in toddlers aged 24-60 months. By providing leaflets outlining the complementary care provided, mothers are happy to be able to practice it at home.

Universitas Nasional funded this program.