What is complete decongestive therapy?

Complete decongestive therapy (CDT) is a noninvasive treatment for lymphedema. The therapy includes a variety of techniques, including manual lymphatic drainage, compression, exercise and skin care. CDT will help your child avoid some of the complications that come from living with lymphedema, a chronic condition that can be managed, but not be cured.

Lymphedema occurs when your child’s lymphatic system is not able to effectively drain or move the lymph fluid out of an area of his body. The lymph fluid can collect in one area of his body, leading to chronic swelling that does not go away on its own.

Complete decongestive therapy has two distinct phases: intensive therapy and maintenance therapy. Intensive therapy, also called active therapy, takes place in a medical setting with a specially trained therapist. Maintenance therapy begins in the medical setting and then continues at home where patients and families use the techniques they learned in therapy.

The goal of complete decongestive therapy is to reduce the swelling from lymphedema, keep future swelling to a minimum, and allow your child to live as active and healthy a life as possible.

Is complete decongestive therapy right for my child?

Complete decongestive therapy can be helpful in managing chronic swelling from lymphedema that does not go away on its own. It is non-invasive and can be used alone, or in conjunction with other therapies, to improve symptoms and quality of life for children with lymphatic conditions.

Your child’s healthcare team will discuss whether complete decongestive therapy would benefit your child, what referrals are needed, and how to schedule an appointment. If you have questions about referring a patient or making an appointment, please call 215-590-5819. To reach our certified lymphedema therapists, please email PTOTlymphedema@email.chop.edu.

What does CDT treat?

Complete decongestive therapy is used to treat primary lymphedema and secondary lymphedema.

Primary lymphedema occurs when a child is born with a poorly working lymphatic system (i.e. lymph nodes or vessels are missing or impaired). Symptoms may be present at birth or can present when the child is older.

The following is a list of conditions often associated with primary lymphedema:

• Lymphatic malformations
• Klippel-Trenaunay-Weber syndrome
• Parkes-Weber syndrome
• Amniotic band syndrome
• Turner syndrome
• CLOVES syndrome
• Prader-Willi syndrome
• Noonan syndrome
• Milroy disease
• Meige syndrome
• Lymphedema-distichiasis syndrome
• Lymphangiodysplasia
• Hennekam syndrome
• CHARGE syndrome

Secondary lymphedema occurs as a result of damage to the lymph nodes or lymph vessels. Damage may be caused by trauma, surgery or radiation during cancer treatment.

Intensive complete decongestive therapy

At The Children’s Hospital of Philadelphia, intensive therapy — sometimes called active therapy — is performed in an outpatient medical setting by physical and occupational therapists who are certified lymphedema therapists. These specially-trained therapists work with physicians to develop and implement a treatment plan to meet your child’s immediate and long-term needs.

Active CDT includes several distinct techniques:

Manual lymphatic drainage

Manual lymphatic drainage (MLD) is a gentle stretching technique that improves the function of the lymphatic system by rerouting lymphatic fluid around blocked areas of the body.

MLD combines gentle stretching of the skin, slow, rhythmic massage, and deep breathing to stimulate the healthy areas of your child’s lymphatic system, and move fluid from the blocked areas back into the rest of the body.

Compression garments and bandages

Compression garments and compression bandages are worn on the affected area of your child’s body to help control swelling from lymphedema. Multilayer compression bandages are often combined with foam to add soft pressure to the affected area of your child’s body.

If your child is treated at CHOP, a physical or occupational therapist will order compression garments to fit your child as part of complete decongestive therapy. These garments are custom-made for each child, with the specific size and needs of your child in mind.

Compression is meant to be worn all the time, with different types of garments or bandages for daytime and nighttime. Your child’s therapist will help you to find the best type of garment for your child.

Exercises

While wearing compression garments or bandages, your child should remain active to help move fluid out of the affected area of the body.

Skin care

When your child's lymphatic system is compromised, it is more prone to infection. Keeping your child’s skin clean and moisturized (with lotion) will help to prevent infections.

Maintenance complete decongestive therapy

When your child is finished with his intensive period of complete decongestive therapy, our certified lymphedema therapists will teach you and your child how to continue his treatment at home. Long-term management of lymphedema symptoms will help your child live an active and healthy life.

Your child will need to wear compression garments and bandages as directed, and continue to perform meticulous skin and nail care to avoid infections. Children with lymphedema are also strongly encouraged to continue exercise while wearing compression garments, to move excess fluid from affected areas and improve overall lymphatic function.

Your child will follow up with our certified lymphedema therapists over time. As your child grows, she will need new compression garments. Our therapists will work with the medical team to fit your child with appropriate garments as she grows.