A pediatric physician assistant is a certified PA who examines, diagnoses and treats patients from birth through adolescence. To become one, you earn a bachelor’s degree, complete an accredited PA program of about 27 months, pass the PANCE for NCCPA certification, get a state license, then build pediatric experience through a job or an optional postgraduate residency.
There is no separate pediatric PA license. Every PA trains as a generalist first, passes the same national exam and then chooses pediatrics through the jobs they take, the experience they log and, if they want proof of that experience, a voluntary credential from NCCPA. The general route to PA-C is covered step by step in our guide on how to become a PA; this page focuses on what changes when the patients are children.
Pediatric Physician Assistant Path at a Glance
| Step | What it involves | Typical time |
|---|---|---|
| Bachelor’s degree | Science prerequisites set by each PA program | About 4 years |
| Patient care experience | Hands-on hours before applying; requirements vary by program | Often 1 to 3 years, overlapping college |
| Accredited PA program | Master’s level, didactic year plus clinical rotations that include pediatrics | About 27 months |
| PANCE and PA-C | National certifying exam from NCCPA after graduation | Within 180 days of eligibility |
| State license | Required in every state and the District of Columbia | Weeks to months, by state |
| Postgraduate residency (optional) | Structured pediatric or pediatric specialty training | Most programs about 12 months |
| Pediatrics CAQ (optional) | 4,000 hours in pediatrics, CME and a specialty exam | At least 2 years of full-time practice |
Most people reach their first pediatric PA job about six to eight years after starting college, depending on how long they spend earning patient care hours. The CAQ, if you pursue it, comes later in the career.
What a Pediatric Physician Assistant Does
PAs practice medicine on teams with physicians and other clinicians. The AAPA describes what PAs do as taking medical histories, conducting physical exams, diagnosing and treating illness, ordering and interpreting tests, developing treatment plans, prescribing medication, counseling on preventive care, performing procedures, assisting in surgery and making hospital rounds. Exact duties depend on the setting, the PA’s experience, the specialty and state law.
In pediatrics, that same scope is applied to patients whose bodies, doses and needs change from month to month. A pediatric PA’s work often includes:
- Well-child visits, growth and developmental checks, and immunization schedules
- Sick visits for ear infections, asthma flares, rashes, injuries and fevers
- Counseling parents and caregivers on nutrition, sleep, safety and medications
- Managing chronic conditions such as asthma, diabetes and ADHD with the care team
- Admitting, rounding on and discharging children in hospital pediatric units
- Assisting in pediatric surgery and handling pre-operative and post-operative care
- Procedures within the PA’s training, such as laceration repair or splinting
Where Do Pediatric PAs Work?
Pediatric PAs work wherever children receive care. Common settings include general pediatric and family practices, children’s hospitals, pediatric emergency departments and urgent care, neonatal intensive care units, and subspecialty clinics such as cardiology, oncology, orthopedics, gastroenterology and endocrinology. School-based health centers and community health centers also employ PAs who see a large share of children.
The setting shapes the day. A PA in a general pediatric clinic may see a steady list of well-child and sick visits, while a PA on a pediatric surgery team splits time between the operating room, the inpatient floor and follow-up clinic. If you are still choosing among fields, our overview of physician assistant specialties compares pediatrics with the other areas PAs enter.
Step 1: Build the Foundation Before PA School
PA programs set their own prerequisites, but most expect a bachelor’s degree with coursework in biology, chemistry, anatomy and physiology, and microbiology, plus psychology and statistics at many schools. The AAPA notes that incoming PA students bring an average of more than 3,000 hours of direct patient contact experience, often from work as medical assistants, paramedics or athletic trainers. Our PA school requirements guide lists the common prerequisites and how to check each program.
If you already know pediatrics is your goal, aim some of those hours at children: pediatric clinics, children’s hospitals, camps for kids with chronic illness, or school health offices. Programs look closely at what kind of work you did, and the difference between hands-on care and general healthcare work is explained in patient care experience vs healthcare experience. Many PA programs take applications through CASPA, and each program decides how it counts your hours.
International clinical work can add range to that record. In IMA’s pre-PA internships, interns work under licensed clinicians in Mombasa, Kenya, or Cusco, Peru, taking part in vital signs, patient intake and triage, basic patient interviews and other noninvasive tasks, along with ward rounds, simulations, community clinics and health education sessions in local schools. Interns do not diagnose, prescribe or perform invasive procedures.
Step 2: Complete an Accredited PA Program
You must graduate from a program accredited by the Accreditation Review Commission on Education for the Physician Assistant (ARC-PA) to sit for the national exam. ARC-PA lists 335 accredited entry-level PA programs by state. AAPA describes these programs as about 27 months long, or three academic years, with more than 2,000 hours of clinical rotations; our breakdown of how long PA school is walks through the didactic and clinical phases.
Pediatrics is a required part of every accredited program, not an elective. The ARC-PA Standards, Sixth Edition, effective September 1, 2025, require that preceptors enable students to meet learning outcomes in pediatrics, “including care for infants, children, and adolescents,” alongside family medicine, emergency medicine, internal medicine, surgery, women’s health and behavioral health.
How Can PA Students Get More Pediatric Experience?
The required pediatrics rotation is a start. Students who want to work with children usually add an elective rotation in a pediatric subspecialty, a children’s hospital or a neonatal unit, and they ask preceptors in those rotations for letters of recommendation. A strong elective often turns into a first job offer, because pediatric practices like to hire PAs they have already trained.
Step 3: Pass the PANCE and Earn the PA-C
The Physician Assistant National Certifying Examination (PANCE) is the exam every new PA takes. According to NCCPA’s certification page, the PANCE has five blocks of 60 questions, with 60 minutes for each block, 45 minutes of total break time and a 15-minute tutorial. It is given year-round at Pearson VUE testing centers.
Key timing rules from NCCPA:
- You can apply up to 180 days before your expected program completion date.
- The earliest test date is seven days after you complete your program.
- Your testing window lasts 180 days.
- You may take the PANCE once in any 90-day period and three times in a calendar year.
- Graduates have six years and six attempts, whichever runs out first, to pass.
Passing earns NCCPA board certification and the right to use PA-C. The PANCE covers all of medicine across the life span, so pediatric content appears alongside adult medicine. Our PANCE blueprint and prep guide explains how the content areas are weighted.
Step 4: Get a State License and Keep Certification Current
The BLS states that all states and the District of Columbia require PAs to be licensed, and that most states require PAs to have an agreement with a supervising physician. Each state board sets its own application steps, and NCCPA certification is one of the criteria all 50 states rely on.
Certification then runs on a 10-year cycle. NCCPA’s maintenance rules require 100 continuing medical education (CME) credits in each of five two-year cycles and a passing result on the PANRE or the longitudinal PANRE-LA by the end of the tenth year. Pediatric CME counts toward the 100 credits, which helps PAs who later pursue the CAQ.
Step 5: Consider a Pediatric PA Residency or Fellowship
Postgraduate PA programs are optional. Many pediatric PAs learn on the job, with a structured onboarding period at their first employer. Others choose a residency or fellowship to move into a demanding area such as pediatric surgery, critical care or neonatology faster.
The Association of Postgraduate PA Programs (APPAP) says most residency programs can be completed in twelve months, some take longer, and they offer an intense, organized mix of clinical and didactic training. APPAP’s member directory includes categories for pediatrics, pediatric specialty care, pediatric surgery and neonatology.
ARC-PA also accredits clinical postgraduate programs on a voluntary basis. Its list of accredited postgraduate programs includes three Texas Children’s Hospital fellowships, in surgery, community surgery and orthopedics, first accredited in 2022. Because accreditation is voluntary, many solid programs are not on that list, so ask each program about its curriculum, supervision and graduate outcomes.
Is a Pediatric Residency Worth It?
A residency trades a year of full PA pay for a trainee stipend and concentrated training. It tends to pay off when you want a competitive pediatric subspecialty, when you are changing specialties after working in adult care, or when you want a faster start in high-acuity settings. For a general pediatric clinic job, most employers hire new graduates directly.
Step 6: Earn the Pediatrics CAQ (Optional)
NCCPA offers a voluntary Certificate of Added Qualifications (CAQ) in Pediatrics for PA-Cs who want to document advanced expertise. Holders can add CAQ-Peds after their credentials. The requirements:
| CAQ component | Pediatrics requirement (NCCPA) |
|---|---|
| Prerequisites | Current PA-C and a valid, unrestricted PA license in at least one U.S. jurisdiction (or unrestricted government practice privileges) |
| CME | At least 75 Category I credits focused on pediatrics in the six years before applying, including 25 in the last two years |
| Recommended course | Pediatric Advanced Life Support or Neonatal Resuscitation Program |
| Experience | At least 4,000 hours (about two years full time) as a PA in pediatrics within six years |
| Attestation | From a physician, lead or senior PA, or postgraduate program director in pediatrics, due within 90 days after your CAQ score |
| Exam | Pediatrics Specialty Exam, 120 multiple-choice questions, at Pearson VUE |
| Time limit | Six years to complete all four components after you start |
| Renewal | Valid ten years; renew with 125 Category I pediatric CME and a passing specialty exam |
The CAQ is not required to work in pediatrics. It is a signal to employers and colleagues, and NCCPA’s own survey of CAQ holders reports that over 50% received or expect a pay increase after earning one.
Pediatric Physician Assistant Salary
The Bureau of Labor Statistics does not publish a separate figure for pediatric PAs, so the best official benchmark is pay for all PAs. According to the BLS Occupational Outlook Handbook, the median annual wage for physician assistants was $135,880 in May 2025. The lowest 10% earned less than $99,380 and the highest 10% earned more than $190,280.
| Work setting (BLS, May 2025) | Median annual wage | Share of PA jobs |
|---|---|---|
| Government | $157,040 median | 3% |
| Outpatient care centers | $153,500 median | 9% |
| Hospitals (state, local and private) | $141,150 median | 26% |
| Educational services | $134,770 median | 3% |
| Offices of physicians | $132,000 median | 53% |
Pediatric PAs work across most of these settings. Those in outpatient pediatric offices tend to sit near the offices of physicians figure, while PAs in children’s hospitals, pediatric emergency care and inpatient subspecialties fall under the hospital line. Experience, region, shift work and call duties move pay as well; our guide to physician assistant salaries covers those factors in more detail.
Job Outlook for Pediatric PAs
The BLS projects PA employment to grow 21% from 2025 to 2035, much faster than average, with about 11,500 openings each year. There were about 168,900 PA jobs in 2025. The BLS points to team-based care models and to PAs being trained more quickly than physicians as reasons for that growth.
For pediatrics specifically, demand follows children’s hospitals, pediatric subspecialty clinics and primary care practices that add PAs to see more patients. A PA with pediatric rotations, a pediatric elective and some pediatric patient care hours from before PA school has a clear story to tell those employers.
Pediatric PA vs Pediatrician
Both care for children, but the training paths differ in length and structure. A pediatrician completes medical school and a pediatrics residency before practicing independently, while a pediatric PA reaches practice after a master’s program and works on a team with physicians. If you are weighing the two, compare the full path to becoming a pediatrician with the PA route above, and look at how much time, independence and specialty flexibility you want. PAs can change specialties later without a new residency, which is one reason many choose the PA route.
Checklist: Your Next Steps
- Confirm prerequisites at three to five PA programs you would apply to.
- Start logging patient care hours, with some of them in settings that serve children.
- Shadow a PA in pediatrics and ask about the rotations and electives they found most useful.
- During PA school, request a pediatric elective in the area you want to work in.
- After you pass the PANCE, decide between a direct-hire pediatric job and a 12-month residency.
- Track pediatric CME from your first year so the CAQ stays an option.
Frequently Asked Questions
How long does it take to become a pediatric physician assistant?
Plan on about six to eight years after high school: roughly four years for a bachelor’s degree, time to earn patient care hours, and about 27 months of PA school, followed by the PANCE and a state license. An optional pediatric residency usually adds about 12 months.
Is there a pediatric PA certification?
Yes, but it is optional. NCCPA offers a Certificate of Added Qualifications in Pediatrics for PA-Cs with at least 4,000 hours of pediatric practice, 75 Category I pediatric CME credits, a physician or senior PA attestation and a passing score on the 120-question Pediatrics Specialty Exam.
Do you need a residency to become a pediatric PA?
No. Most pediatric PAs are hired directly after passing the PANCE and train on the job. A postgraduate residency or fellowship, which APPAP says usually lasts about twelve months, is a choice for PAs who want a faster start in surgery, critical care, neonatology or another pediatric specialty.
Can a PA switch to pediatrics after working in another specialty?
Yes. PAs train as generalists and hold one national certification, so moving into pediatrics does not require a new degree or exam. APPAP notes that a postgraduate program can help an experienced PA change specialty areas. If you are still choosing a profession, our NP vs PA comparison explains how the two roles differ.
How much does a pediatric physician assistant make?
BLS does not report pediatric PAs separately. For all physician assistants, the median annual wage was $135,880 in May 2025, with the lowest 10% under $99,380 and the highest 10% over $190,280. Hospital PAs had a median of $141,150 and PAs in offices of physicians $132,000.
Can a pediatric PA work in the NICU?
Yes. PAs work in neonatal intensive care units, often after a neonatology residency or fellowship or a period of on-the-job training. APPAP’s directory of postgraduate programs includes a neonatology category, and NCCPA recommends the Neonatal Resuscitation Program or PALS for PAs pursuing the Pediatrics CAQ.
Do PA programs require a pediatrics rotation?
Yes. The ARC-PA Standards, Sixth Edition, effective September 1, 2025, require every accredited program to prepare students in pediatrics, including care for infants, children and adolescents, through supervised clinical practice experiences.
