Mothers’ experiences implementing Local Food-Based Feeding Recommendations (LFFRs) for stunted children in Malang, Indonesia: a narrative study

Hayu Iyaka Nastaina* -  Department of Nutrition, Faculty of Health Science, Universitas Brawijaya, Indonesia
Nia Novita Wirawan -  Department of Nutrition, Faculty of Health Science, Universitas Brawijaya., Indonesia
Annisa Rizky Maulidiana -  Department of Nutrition, Faculty of Health Science, Universitas Brawijaya., Indonesia
Local Food-Based Feeding Recommendations (LFFRs) were developed to fulfill the nutritional needs of stunted toddlers but remain underexplored in community settings. This study systematically examined child feeding practices based on LFFRs and investigated the contextual factors, challenges, and strategic efforts influencing their implementation by mothers of toddlers. A qualitative narrative design was used. Six mothers of toddlers were purposively selected and participated in in-depth interviews, each lasting 45–60 min. Data collection was conducted over two months. Thematic analysis was used to identify key patterns, and source triangulation was applied to enhance the credibility and trustworthiness of the findings. The analysis of the interview data revealed five main categories and 12 subthemes. These main categories were: (1) Overview of LFFRs implementation, (2) Factors influencing TIPs LFFRs, (3) Challenges in implementing TIPs LFFRs, and (4) Strategies to improve children's intake.  The findings revealed varied consumption patterns, with animal-based proteins (mainly eggs and chicken) dominating, limited intake of plant-based proteins (primarily tofu and tempeh), and fluctuating fruit, vegetable, and dairy consumption. Key barriers included children’s food preferences, time constraints, limited knowledge of local food preparation (e.g., wader fish and fresh milk), and perceived food-related risks. Adaptive strategies, such as diverse food processing and small frequent feedings, were employed by some mothers. These findings highlight the need for context-specific nutrition education and practical support for mothers, complemented by further research, evidence-based visual modules, practical caregiver training, and strengthened cross-sectoral collaboration to ensure the sustainable implementation of LFFRs and local food availability.

Keywords : LFFRs, toddlers, stunting, feeding practices, local food, qualitative study, nutrition education

  1. Alhidayati, A., Natassa, J., Vita Gloria Purba, C., & Dewi, M. (2023). Perilaku Konsumsi Sayur Dan Buah Pada Anak Usia Dini Taman Kanak-Kanak Wilayah Kerja Puskesmas Ri Sidomulyo. Al-Tamimi Kesmas: Jurnal Ilmu Kesehatan Masyarakat (Journal of Public Health Sciences), 12(1), 41–56. https://doi.org/10.35328/kesmas.v12i1.2430
  2. Brouwer, I. D., Jager, I. de, Borgonjen, K., Azupogo, F., Rooij, M., Folson, G., & Abizari, R. (2017). Development of food-based dietary recommendations for children, 6-23 months old, in Karaga District and Gomoa East District, Ghana. Global Alliance for Improved Nutrition, May, 1–127.
  3. Choi, E. B., Lee, J. E., & Hwang, J. Y. (2018). Fruit and Vegetable Intakes in Relation to Behavioral Outcomes Associated with A Nutrition Education Intervention in Preschoolers. Nutrition Research and Practice, 12(6), 521–526. https://doi.org/10.4162/nrp.2018.12.6.521
  4. Darma, A., Sumitro, K. R., Jo, J., & Sitorus, N. (2024). Lactose Intolerance versus Cow’s Milk Allergy in Infants: A Clinical Dilemma. Nutrients, 16(3). https://doi.org/10.3390/nu16030414
  5. Gu, Y., Peng, W., Luo, B., Zhao, X., Zhao, L., Tang, Y., Guo, X., & Liu, X. (2025). Feeding behavior in caregivers of 6- to 24-month-old infants and young children: a cross-sectional study from a district in a first-tier city in the southwestern region of China. BMC Pediatrics, 25(1). https://doi.org/10.1186/s12887-025-05622-8
  6. Harrison, L., Padhani, Z., Salam, R., Oh, C., Rahim, K., Maqsood, M., Ali, A., Charbonneau, K., Keats, E. C., Lassi, Z. S., Imdad, A., Owais, A., Das, J., & Bhutta, Z. A. (2023). Dietary Strategies for Complementary Feeding between 6 and 24 Months of Age: The Evidence. Nutrients, 15(13). https://doi.org/10.3390/nu15133041
  7. Headey, D., Hirvonen, K., & Hoddinott, J. (2018). Animal sourced foods and child stunting. American Journal of Agricultural Economics, 100(5), 1302–1319. https://doi.org/10.1093/ajae/aay053
  8. Hlaing, L. M., Fahmida, U., Htet, M. K., Utomo, B., Firmansyah, A., & Ferguson, E. L. (2016). Local Food-based Complementary Feeding Recommendations Developed by The Linear Programming Approach to Improve The Intake of Problem Nutrients Among 12-23-month-old Myanmar children. British Journal of Nutrition, 116(S1), S16–S26. https://doi.org/10.1017/S000711451500481X
  9. Kadim, M., Karyana, I. P. G., Darma, A., Yosia, M., Basrowi, R. W., Dilantika, C., Sundjaya, T., & Wasito, E. (2024). Current Landscape and Overview of Gastrointestinal Health in Indonesian Children: A Scoping Review. The Open Public Health Journal, 17(1), 1–13. https://doi.org/10.2174/0118749445339403240916105656
  10. Kähkönen, K., Sandell, M., Rönkä, A., Hujo, M., & Nuutinen, O. (2021). Children’s fruit and vegetable preferences are associated with their mothers’ and fathers’ preferences. Foods, 10(2), 1–14. https://doi.org/10.3390/foods10020261
  11. Kamudoni, P., Kiige, L., Ortenzi, F., Beal, T., Nordhagen, S., Kirogo, V., Arimi, C., Zvandaziva, C., Garg, A., Codjia, P., & Rudert, C. (2024). Identifying and Understanding Barriers to Optimal Complementary Feeding in Kenya. Maternal and Child Nutrition, 20(S3), 1–7. https://doi.org/10.1111/mcn.13617
  12. Khaliq, A., Usmani, I. A., Rizwan, Y., Khan, M., Khan, A. S., Saleem, N. ul A., & Junaid, M. (2025). Cross-Sectional Analysis of Food Group Consumption and Obesity in Children Aged 6–23 Months with Normal and Stunted Growth Patterns in Pakistan. Obesities, 5(3), 55. https://doi.org/10.3390/obesities5030055
  13. Khamis, A. G., Mwanri, A. W., Ntwenya, J. E., & Kreppel, K. (2019). The influence of dietary diversity on the nutritional status of children between 6 and 23 months of age in Tanzania. BMC Pediatrics, 19(1), 1–9. https://doi.org/10.1186/s12887-019-1897-5
  14. Lakkakula, A., Geaghan, J., Zanovec, M., Pierce, S., & Tuuri, G. (2010). Repeated taste exposure increases liking for vegetables by low-income elementary school children. Appetite, 55(2), 226–231. https://doi.org/10.1016/j.appet.2010.06.003
  15. Lott, M., Callahan, E., Welker, D. E., Story, M., & Daniels, S. (2019). Technical Scientific Report: Healthy Beverage Consumption in Early Childhood: Recommendations from Key National Health and Nutrition Organizations. In Healthy Eating Research (Issue 1111). https://healthyeatingresearch.org/research/technical-scientific-report-healthy-beverage-consumption-in-early-childhood-recommendations-from-key-national-health-and-nutrition-organizations/
  16. Marinho, C. S., Koch, C., & Santos, M. R. (2023). Eating habits: what foods do children between 12 and 36 months consume? Revista Brasileira de Enfermagem, 76(4), 1–8. https://doi.org/10.1590/0034-7167-2022-0393
  17. Matiri, E., Ramirez, L., Elmi, A., Gaithuma, J., Kavithe, R., Waweru, M., Kahiga, M., & Kavle, J. A. (2025). Tailoring Trials of Improved Practices (TIPs) to Improve Child Feeding and Use of Indigenous Preserved Foods in Drought-Affected Kenya: Considerations for Climate Shocks. Maternal and Child Nutrition, 21(3). https://doi.org/10.1111/mcn.70018
  18. McCann, J., Beckford, K., Beswick, H., Chisholm, M., & Woods, J. (2022). Toddler foods and milks don’t stack up against regular foods and milks. Nutrition Journal, 21(1), 1–8. https://doi.org/10.1186/s12937-022-00765-1
  19. Medemblik, J. M., Conlon, C. A., Haszard, J. J., Heath, A. L. M., Taylor, R. W., von Hurst, P., Beck, K. L., Te Morenga, L., & Daniels, L. (2024). Parent-reported offering of allergen foods to infants during complementary feeding: An observational study of New Zealand infants. Appetite, 203(September), 107709. https://doi.org/10.1016/j.appet.2024.107709
  20. Millen, L., Overcash, F., Vickers, Z., & Reicks, M. (2019). Implementation of Parental Strategies to Improve Child Vegetable Intake: Barriers and Facilitators. Global Pediatric Health, 6. https://doi.org/10.1177/2333794X19855292
  21. Nantel, A., & Gingras, V. (2023). Are Complementary Feeding Practices Aligned with Current Recommendations? A Narrative Review. Children, 10(5), 1–21. https://doi.org/10.3390/children10050794
  22. Neufingerl, N., & Eilander, A. (2023). Nutrient Intake and Status in Children and Adolescents Consuming Plant-Based Diets Compared to Meat-Eaters : A Systematic Review. Nutrients, 15(4341). https://doi.org/https://doi.org/10.3390/nu15204341
  23. Nurokhmah, S., Middleton, L., & Hendarto, A. (2022). Prevalence and Predictors of Complementary Feeding Practices Among Children Aged 6-23 Months in Indonesia. Journal of Preventive Medicine and Public Health, 55(6), 549–558. https://doi.org/10.3961/jpmph.22.199
  24. Palupi, E., Oktaviani, R. I., Purnaningsih, N., Saraswati, Y., Putri, W. E., & Iwansyah, A. C. (2025). Development of wader-fish (Rasbora argyrotaenia) and kidney beans as a supplementary food: A source of protein and minerals for toddlers aged 12-24 months. BIO Web of Conferences, 153. https://doi.org/10.1051/bioconf/202515303012
  25. Quinn, M., Herty, L., Weeks, H. M., Kwan, J., Haines, J., & Bauer, K. W. (2022). Low-income mothers’ perspectives on the involvement of family members in child feeding. Appetite, 168(November 2020). https://doi.org/10.1016/j.appet.2021.105683
  26. Seifu, B. L., Fente, B. M., Asmare, Z. A., Asnake, A. A., Bezie, M. M., Asebe, H. A., Melkam, M., & Negussie, Y. M. (2024). Factors associated with zero vegetable and fruit consumption among Tanzanian children. BMC Public Health, 24(1), 3039. https://doi.org/10.1186/s12889-024-20472-2
  27. Silveira, A., Pinheiro Carvalho, J., Loh, L., & Benusic, M. (2023). Public Health Risks of Raw Milk Consumption: Lessons from A Case of Paediatric Hemolytic Uremic Syndrome. Canada Communicable Disease Report, 49(09), 375–379. https://doi.org/10.14745/ccdr.v49i09a03
  28. Tahreem, A., Rakha, A., Anwar, R., Rabail, R., Maerescu, C. M., Socol, C. T., Criste, F. L., Abdi, G., & Aadil, R. M. (2024). Impact of maternal nutritional literacy and feeding practices on the growth outcomes of children (6–23 months) in Gujranwala: a cross-sectional study. Frontiers in Nutrition, 11(January). https://doi.org/10.3389/fnut.2024.1460200
  29. Tomaszewski, L. E., Zarestky, J., & Gonzalez, E. (2020). Planning Qualitative Research: Design and Decision Making for New Researchers. International Journal of Qualitative Methods, 19, 1–7. https://doi.org/10.1177/1609406920967174
  30. WHO. (2023). WHO guideline for complementary feeding of infants and young children 6–23 months of age. In World Health Organization. https://doi.org/10.24815/jik.v10i1.2378
  31. Wirawan, N. N., Fahmida, U., Purwestri, R. C., Timan, I. S., & Hegar, B. (2023). Development of Food Multi-Mix Using a Linear Programming Approach to Fill the Nutrient Gap of Amino Acids and Micronutrients for Stunted Non-Wasted Children. Foods, 12(1). https://doi.org/10.3390/foods12010064

Open Access Copyright (c) 2025 Hayu Iyaka Nastaina, Nia Novita Wirawan, Annisa Rizky Maulidiana
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