- The credential is NCCPA's Pediatrics CAQ, earned on top of PA-C; it is not PANCE, PANRE, or a physician board exam.
- Initial cost is $350: $100 program registration plus $250 exam. A retake within the six-year window costs $250.
- You need 4,000 pediatric PA hours and 75 pediatric Category I CME credits (25 in the last two years), all within six years.
- The exam is 120 multiple-choice questions in two 60-question, 60-minute blocks at a Pearson VUE test center.
What This Credential Actually Is
Searches for "PA-CP" lead to this credential: the Certificate of Added Qualifications in Pediatrics (CAQ-Peds), issued by the National Commission on Certification of Physician Assistants (NCCPA). It is held alongside the PA-C and signals demonstrated experience and knowledge in pediatric practice. If you want the plain-language definitions first, see What Is PA-CP? and What Does PA-CP Stand For?.
Keep the scope straight, because the most common mistake is blending this exam with others. This credential covers initial Pediatrics CAQ qualification only. It is not PANCE (the entry-level PA certifying exam), not PANRE (the general recertification exam), and not a pediatrics board examination for physicians. Everything on this page applies to the Pediatrics CAQ and nothing else.
The Numbers at a Glance
This table is the core of the cheat sheet. Every figure below comes from NCCPA's published specialty-certificate materials.
| Item | Must-Know Fact |
|---|---|
| Governing body | NCCPA |
| Testing provider | Pearson VUE test centers |
| Total fee | $350 ($100 program registration + $250 examination) |
| Additional attempt | $250, within the six-year window |
| Completion window | Six years to complete initial requirements |
| Pediatric PA experience | 4,000 hours in the preceding six years |
| Pediatric Category I CME | 75 credits in six years, including 25 in the preceding two years |
| Exam length | 120 multiple-choice questions |
| Exam structure | Two blocks of 60 questions, 60 minutes each |
| Extra test-day time | 15-minute tutorial plus a separate 15-minute break |
| Attestation deadline | Within 90 days of the score report |
| Validity | Ten years |
| Maintenance CME | 125 pediatric Category I credits during the cycle |
For a deeper look at how these costs add up in practice, including retake planning, read the PA-CP Certification Cost breakdown.
Eligibility Checklist
Run through these requirements before paying any fees. The full discussion lives in PA-CP Requirements: Eligibility, Prerequisites & How to Qualify, but the essentials fit on a checklist.
Credential and licensure
- A current PA-C credential.
- Unrestricted PA licensure in a US jurisdiction or territory, or unrestricted government practice privileges.
- Every license you hold must be unrestricted. A restriction on any one of them is a problem, even if your primary practice license is clean.
Experience and education
- 4,000 hours of pediatric PA experience within the preceding six years.
- 75 pediatric Category I CME credits within six years, with at least 25 earned in the preceding two years.
Recommended, not required
- A PALS or Neonatal Resuscitation Program (NRP) course is recommended but is not an eligibility requirement. Do not delay your application waiting on it, but it is sensible preparation for the resuscitation-adjacent material pediatric clinicians see.
Exam Format and Test-Day Mechanics
The exam is delivered at Pearson VUE test centers and consists of 120 multiple-choice questions split into two 60-question blocks, each timed at 60 minutes. That is two hours of testing, which works out to roughly one minute per question. Separate from that testing time, you get a 15-minute tutorial before you begin and a 15-minute break between blocks.
What the pacing means
- One minute per item rewards clinicians who recognize patterns quickly. Long deliberation on a single question comes directly out of later items in the same block.
- Because the blocks are separately timed, you cannot bank spare minutes from block one for block two.
- The break is separate from testing time, so use it to reset rather than to cram.
For context on how candidates experience the difficulty of this format, see How Hard Is the PA-CP Exam?. If you are wondering about scoring thresholds and result reporting, the PA-CP Passing Score and PA-CP Pass Rate guides address what is and is not publicly known.
The Twelve Verified Topic Lines
A caution up front, because it matters for how you study. NCCPA's comprehensive current Pediatrics content blueprint could not be retrieved when this article was prepared, so no official domain weights or complete objective list are asserted here. The twelve topics below are the content-area labels that appear in NCCPA's published Sample Pediatrics Questions and Critiques (copyright 2021), listed in order of first appearance. Treat them as preparation-example topics, not as an exhaustive curriculum, an official count of exam domains, or a weighted blueprint. No domain is claimed to be the most heavily tested.
Check NCCPA's current materials for the authoritative blueprint, and use the walkthrough in PA-CP Exam Domains: Complete Guide to All 12 Content Areas for how candidates approach each area.
1. Health Maintenance
Well-child care is the backbone of pediatric primary care.
- Preventive visit content across age groups
- Immunization decisions and scheduling logic
- Anticipatory guidance and screening
2. Infectious Diseases
Common pediatric infections and their management.
- Recognizing presentations that differ from adults
- Treatment and prevention decisions
- Knowing when a presentation demands escalation
3. Cardiovascular Disorders
Pediatric cardiac findings differ sharply from adult cardiology.
- Distinguishing benign findings from those needing referral
- Age-appropriate evaluation approaches
4. Psychiatry and Behavioral Medicine
Behavioral and mental health concerns are a large share of modern pediatric practice.
- Developmentally appropriate assessment
- First-line management and referral thresholds
5. Eyes, Ears, Nose and Throat
High-volume complaints in any pediatric clinic.
- Common pediatric presentations
- Treatment choices and complication recognition
6. Gastrointestinal/Nutrition Disorders
Feeding, growth, and GI problems across ages.
- Age-specific differentials
- Nutritional assessment and management
7. Musculoskeletal Disorders
Growing skeletons produce conditions adults never see.
- Pediatric-specific orthopedic problems
- Recognizing red flags in limp and pain complaints
8. Sports Medicine
Youth athletes bring injury patterns tied to growth and activity.
- Injury evaluation and return-to-activity reasoning
- Overuse versus acute injury
9. Genitourinary/Reproductive Disorders
Urologic, gynecologic, and pubertal topics in children and adolescents.
- Age-appropriate evaluation
- Sensitive-care considerations for adolescents
10. Congenital Anomalies and Genetic Disorders
A distinctly pediatric content area with no real adult-medicine analog.
- Recognizing syndromic features
- Appropriate evaluation and referral pathways
11. Hematology/Oncology
Blood disorders and childhood malignancy presentations.
- Recognizing early signs that warrant workup
- Initial evaluation and referral
12. Endocrine Disorders
Growth, puberty, and metabolic conditions.
- Interpreting growth patterns
- Recognizing common pediatric endocrine presentations
Official Practice Resources
NCCPA offers two distinct practice resources, and they do different jobs. Mixing up what each provides is an easy way to misjudge your readiness.
| Feature | Sample Questions and Critiques | NCCPA Pediatrics Practice Exam |
|---|---|---|
| Cost | Free | $50 |
| Length | A set of sample items | 60 questions, 60 minutes |
| Access | Downloadable document | 180-day access |
| Answer explanations | Yes, critiques explain the answers | No item-level explanations |
| Predicts passing? | No | No |
The free critiques are your best source of reasoning practice, since they tell you why an answer is correct. The paid practice exam is useful for rehearsing timing and format, but it will not explain your misses and does not predict whether you will pass. Use them together: critiques to learn, the practice exam to simulate pacing. Adding a third-party question bank such as the PA-CP Exam Prep practice tests gives you additional explained items to fill the gap the official practice exam leaves.
Key Takeaway
Do not treat the 60-question official practice exam as a pass/fail forecast. It is a pacing rehearsal at roughly half the length of the real exam. Your readiness signal should come from explained-question review across all twelve topic areas.
The Attestation Step
Passing the exam is not the final administrative step. NCCPA requires an attestation to relevant pediatric patient cases and procedures. The attestor must be a specialty physician, a lead or senior PA, or a physician or PA postgraduate program director who is familiar with you and your work. NCCPA publishes a Pediatrics Procedures/Patient Case Attestation form (dated June 2, 2022) for this purpose.
The deadline is firm: submit within 90 days of the score report.
How to avoid a last-minute scramble
- Identify your attestor before you sit for the exam, not after.
- Choose someone who has actually observed your pediatric work, since they are attesting to specific cases and procedures.
- Review the current form early so you know which cases and procedures you will be asked to document.
The documentation requirement is one reason experience records matter. If you work in a setting where your pediatric volume is hard to demonstrate, start collecting that documentation now. The employers most likely to value and support this credential are pediatric primary care practices, children's hospitals, pediatric subspecialty clinics, urgent care and emergency settings with significant pediatric volume, and school-based or community health programs. For the job-market angle, see PA-CP Jobs and the PA-CP Salary Guide, and for a value judgment, Is the PA-CP Certification Worth It?
The Ten-Year Cycle
The credential is valid for ten years. To keep it, you must:
- Maintain your PA-C and unrestricted licensure throughout.
- Complete 125 pediatric Category I CME credits during the cycle.
- Pass a maintenance examination.
Maintenance offers both test-center and online open-reference options, and these are distinct from the initial qualification exam. The online maintenance format allows five minutes per question, a very different pace from the roughly one-minute-per-item rhythm of the initial exam. Do not carry maintenance-format assumptions into your initial exam preparation: the initial exam is a timed, closed test-center experience.
Sequencing Your Prep
You do not need an elaborate system. What matters is matching your study order to where a practicing PA is typically weakest. Because no official domain weights are confirmed, spread your time across all twelve topic lines rather than betting on a few. A reasonable approach is to front-load the areas furthest from your day-to-day practice, then finish with mixed timed sets that mirror the 60-question block format. The PA-CP Study Guide covers the full method; here is a compact example schedule built around the topic lines above.
Least-familiar content first
- Congenital Anomalies and Genetic Disorders
- Hematology/Oncology
- Endocrine Disorders
Growth, development, and systems
- Health Maintenance
- Gastrointestinal/Nutrition Disorders
- Genitourinary/Reproductive Disorders
Organ systems and movement
- Cardiovascular Disorders
- Musculoskeletal Disorders
- Sports Medicine
High-volume clinic content, then timed practice
- Infectious Diseases
- Eyes, Ears, Nose and Throat
- Psychiatry and Behavioral Medicine
- Two timed 60-question, 60-minute blocks with a review of every miss
The logic: familiar high-volume topics like ENT and infections are the ones you already reinforce at work, so they need the least dedicated time and make a good final review. The rare-but-testable areas need the most deliberate effort early, while there is still time to revisit them. Once you have a working command of the content, schedule your exam using the guidance in PA-CP Exam Dates: Testing Windows, Deadlines & Scheduling, and keep your six-year window in mind when you plan.
Frequently Asked Questions
No. This is the Pediatrics Certificate of Added Qualifications (CAQ), earned in addition to your PA-C. It is neither the PANCE entry exam nor the PANRE recertification exam, and it is not a physician pediatrics board examination.
The total is $350, made up of a $100 program registration fee and a $250 examination fee. An additional exam attempt within the six-year window costs $250. Details are in the certification cost breakdown.
You need 4,000 hours of pediatric PA experience in the preceding six years and 75 pediatric Category I CME credits in six years, including 25 in the preceding two years. You must also hold a current PA-C and unrestricted licensure, with every held license unrestricted.
No. A PALS or Neonatal Resuscitation Program course is recommended but not required for eligibility.
Your attestation, completed by a specialty physician, lead or senior PA, or postgraduate program director who knows your work, must be submitted within 90 days of the score report. The credential then remains valid for ten years, with 125 pediatric CME credits and a maintenance exam required to keep it.
Bookmark this page as your quick-reference summary, and when you are ready to test your recall under realistic conditions, work through timed sets on the main practice test site. For the broader overview of the credential, start with PA-CP Certification.