- What the Credential Actually Is
- Who Certifies and Who Delivers the Exam
- Eligibility: The Traditional Pathway
- Exam Format and Scoring
- The 19-Domain Content Outline
- Fees and Registration Mechanics
- How Candidates Fare
- Sequencing Your Preparation by Domain
- After You Pass: Continuing Certification and Careers
- Frequently Asked Questions
- Certification in Pediatric Pulmonology is issued by the American Board of Pediatrics (ABP), with testing delivered through Prometric.
- The exam has roughly 200 multiple-choice questions and a passing scaled score of 180 on a 1-300 scale.
- The outline effective November 1, 2026 has 19 domains; Asthma is the largest at 9%.
- The regular indexed fee is $2,992, including a $750 processing component.
What the Credential Actually Is
Certification in Pediatric Pulmonology is the subspecialty board credential awarded to pediatricians who complete advanced training in diseases of the pediatric respiratory system and then pass a secure, proctored examination. It signals that a physician has the knowledge to manage conditions ranging from extreme prematurity-related lung disease to cystic fibrosis, severe asthma, interstitial lung disease, sleep-disordered breathing, and chronic respiratory failure in children and young adults.
It is a subspecialty certificate layered on top of general pediatrics certification. It is not an entry-level credential, and it is not a respiratory therapy, nursing, or adult pulmonary and critical care credential. If you are looking for a broader orientation to the field itself, our explainer What Is Pediatric Pulmonology? covers the specialty, while this article focuses on the board certification.
Who Certifies and Who Delivers the Exam
The certifying body is the American Board of Pediatrics (ABP). The ABP sets eligibility rules, writes and approves the content outline, determines the passing standard, and issues the certificate. The examination itself is administered at Prometric testing centers, so candidates register through the ABP and then schedule a seat through the testing vendor.
Because the ABP publishes its own content outline and examination calendar, the board's website is the authoritative source for anything time-sensitive. The official outline lives at the ABP pulmonology content outline PDF, the schedule is on the ABP subspecialty exam dates and fees page, and past and current versions are collected in the ABP subspecialty content outline directory.
Eligibility: The Traditional Pathway
The traditional route to initial certification has several layers:
- A medical (MD) or osteopathic (DO) degree.
- Certification in general pediatrics.
- Completion of a three-year subspecialty fellowship in pediatric pulmonology.
- Fulfillment of the scholarly activity requirements attached to fellowship training.
- Severity classification, control assessment, and stepwise therapy adjustments
- Phenotyping severe and difficult-to-treat asthma, including when biologic therapy enters the discussion
- Differentiating asthma from mimics such as vocal cord dysfunction and airway malacia
- Comorbid contributors: allergy, reflux, obesity, rhinosinusitis, adherence and technique problems
- Pulmonary function testing interpretation: spirometry patterns, lung volumes, diffusing capacity, and infant or preschool techniques
- Bronchoscopy and bronchoalveolar lavage: indications and interpretation
- Imaging, oximetry, capnography, and polysomnography as monitoring and diagnostic tools
- Chronic cough, wheeze, stridor, hemoptysis, and recurrent pneumonia workups
- Choosing the right initial test and recognizing red flags that change the pathway
- CF: diagnosis, CFTR modulator concepts, pulmonary exacerbation management, nutritional and extrapulmonary complications
- Non-CF bronchiectasis: etiologies such as primary ciliary dyskinesia, immunodeficiency, and post-infectious causes, plus airway clearance strategies
- Study design, interpreting evidence, and basic biostatistical reasoning
- Health equity concepts as they apply to pediatric respiratory care and outcomes
- Core Principles of Pulmonary Diagnosis and Monitoring Techniques (8%): PFT patterns, bronchoscopy findings, polysomnography
- Lung Development and Physiology (6%): the physiology that underpins every interpretation question
- Common Signs and Symptoms (8%): symptom-to-workup reasoning
- Asthma (9%), including severe asthma phenotypes and therapy escalation
- Cystic Fibrosis (6%) and Non-CF Bronchiectasis (4%)
- Respiratory Infections (6%)
- Respiratory Disorders of the Neonate and Infant (5%) and Congenital and Acquired Malformations (5%)
- Interstitial Lung Disease (5%) and Restrictive Disease (5%)
- Respiratory Failure (5%)
- Sleep-Disordered Breathing and Control of Breathing, Pulmonary Vascular and Lymphatic Diseases, Systemic Disorder Associations, Environmental Exposures
- Respiratory System Under Stress, Other Disorders, and Scholarly Activities and Health Equity
- Timed mixed-domain question sets and review of missed items
Two caveats matter. First, current license and attestation details should be confirmed directly with the ABP, since documentation requirements can be updated. Second, the ABP has announced a new training model, and how it applies to a given candidate requires confirmation with the board rather than assumption. For a deeper walkthrough of prerequisites, see Pediatric Pulmonology Requirements 2026: Eligibility, Prerequisites & How to Qualify, and for the training side, see Pediatric Pulmonology Training.
Exam Format and Scoring
The initial certification exam consists of approximately 200 multiple-choice questions. Questions are clinical in orientation: expect vignettes describing a child with a presentation, a set of findings (spirometry, imaging, bronchoscopy, polysomnography, genetic or sweat chloride results), and a question about the best next step, most likely diagnosis, mechanism, or management decision.
Scaled scoring, not a raw percentage
The passing standard is a scaled score of 180 on a 1-300 scale. That is not the same as answering 60% correctly. Scaled scores adjust for differences in form difficulty so that a given score represents the same level of performance across administrations. Candidates who try to convert 180 into a raw percentage target will be working from a false premise; the practical goal is broad, reliable command of the whole outline. Our dedicated article, Pediatric Pulmonology Passing Score 2026: Exactly What You Need to Pass, unpacks this in more detail.
Rules that remain unverified
Details such as whether initial-certification candidates may use open-book resources, a calculator, remote proctoring, or particular break arrangements are not verified here. Do not assume the rules of a different board exam apply. Confirm testing-day rules in your ABP candidate communications.
The 19-Domain Content Outline
The current ABP Pediatric Pulmonology initial-certification content outline, effective November 1, 2026, contains 19 domains with approximate published weights that total 100%. It applies to the upcoming November 5, 2026 initial-certification examination. Note that the October 2025 subboard approval date is not the effective date; the outline governs exams on and after November 1, 2026. Published versions may vary slightly, so always cross-check against the official PDF.
| Domain | Approx. Weight |
|---|---|
| 1. Lung Development and Physiology | 6% |
| 2. Common Signs and Symptoms | 8% |
| 3. Respiratory Disorders of the Neonate and Infant | 5% |
| 4. Congenital and Acquired Malformations of the Airways and Lungs | 5% |
| 5. Respiratory Infections | 6% |
| 6. Cystic Fibrosis (CF) | 6% |
| 7. Non-CF Bronchiectasis | 4% |
| 8. Asthma | 9% |
| 9. Sleep-Disordered Breathing and Control of Breathing Disorders | 4% |
| 10. Restrictive Disease | 5% |
| 11. Respiratory Failure | 5% |
| 12. Interstitial Lung Disease | 5% |
| 13. Pulmonary Vascular and Lymphatic Diseases | 4% |
| 14. Lung Disease Associated with Systemic Disorders | 4% |
| 15. Environmental Injuries and Exposures (Acute and Chronic) | 4% |
| 16. Respiratory System Under Stress | 3% |
| 17. Other Disorders of the Respiratory System | 5% |
| 18. Core Principles of Pulmonary Diagnosis and Monitoring Techniques | 8% |
| 19. Core Knowledge in Scholarly Activities and Health Equity | 4% |
What the weights tell you
Asthma at 9% is the largest single domain, but it is only one slice. The three domains at 8% or 9% (Asthma, Common Signs and Symptoms, and Core Principles of Pulmonary Diagnosis and Monitoring Techniques) together make up a quarter of the outline. Meanwhile, many mid-weight domains sit at 4-6%, meaning a candidate cannot afford to skip an entire disease category and hope to compensate elsewhere. For a domain-by-domain breakdown, see Pediatric Pulmonology Exam Domains 2026: Complete Guide to All 19 Content Areas.
Asthma (9%)
The heaviest-weighted domain rewards depth beyond first-line therapy.
Core Principles of Pulmonary Diagnosis and Monitoring Techniques (8%)
This is the interpretive heart of the specialty and a domain where precision pays off.
Common Signs and Symptoms (8%)
Symptom-first reasoning: the exam often starts with a complaint, not a diagnosis.
Cystic Fibrosis (6%) and Non-CF Bronchiectasis (4%)
Two separate domains that reward distinct knowledge.
Core Knowledge in Scholarly Activities and Health Equity (4%)
Often underestimated because it is not a disease category.
Fees and Registration Mechanics
The official indexed regular fee for the examination is $2,992, which includes a $750 processing component. Registration is handled through the ABP, and the exam is then delivered through Prometric. Because deadlines and fee tiers are published on the ABP's exam dates and fees page, check that page for the exact registration window tied to the November 5, 2026 sitting rather than relying on a cached figure. For a full pricing view, including what candidates commonly overlook, see Pediatric Pulmonology Certification Cost 2026: Complete Pricing Breakdown, and for scheduling logistics see Pediatric Pulmonology Exam Dates 2026: Testing Windows, Deadlines & Scheduling.
How Candidates Fare
The latest verified first-time national pass rate is 73% in 2024, compared with 68% in 2022, as reported in a 2026 primary paper citing ABP data. That is a useful signal: the exam is passable for well-prepared fellowship graduates, but a meaningful fraction of first-time candidates do not pass. No firmer claim should be made about repeat-taker rates or about year-to-year trends beyond those two data points.
Pass-rate numbers describe candidates who have completed fellowship, so they say little about how a casual or underprepared test-taker would perform. For more context, read Pediatric Pulmonology Pass Rate 2026: What the Data Shows and How Hard Is the Pediatric Pulmonology Exam? Complete Difficulty Guide 2026.
Sequencing Your Preparation by Domain
Rather than generic study advice, the most useful planning tool is the outline itself. A sensible approach is to front-load the high-weight, high-interpretation domains, then cycle through the organ-system and disease-specific content, and reserve the final stretch for integration and timed practice. A sample arrangement built around the 19 domains:
Diagnostic Foundations
The Big Chronic Conditions
Neonatal, Structural, and Parenchymal Disease
Breadth, Gaps, and Integration
Adjust the pacing to your calendar; the principle is to tie each block to specific outline weights rather than studying whatever feels most familiar. For a fuller plan, see the Pediatric Pulmonology Study Guide 2026: How to Pass on Your First Attempt, and for last-pass review, the Pediatric Pulmonology Cheat Sheet 2026: One-Page Review of Must-Know Facts. When you are ready to test yourself under exam-like conditions, work through the Pediatric Pulmonology practice questions on the main site and use your misses to redirect study time to the domains that need it.
Key Takeaway
Use the published weights as a scheduling tool, not a skipping tool. With 19 domains and several at only 3-5%, a candidate who ignores the smaller domains forfeits points that a scaled 180 cut score makes costly to lose.
After You Pass: Continuing Certification and Careers
Certification is not a one-time event. Continuing certification follows a five-year cycle, and diplomates maintain the credential through either MOCA-Peds or an examination pathway. Because program rules evolve, confirm the current requirements with the ABP as your cycle approaches.
On the career side, board-certified pediatric pulmonologists are typically found in children's hospitals, academic medical centers with pediatric pulmonary divisions, multispecialty pediatric groups, and CF care centers, with additional roles in sleep medicine programs, chronic ventilation and tracheostomy clinics, and research. Board certification is commonly expected for faculty appointments and many hospital privileging and credentialing decisions. For market-facing detail, see Pediatric Pulmonology Jobs, Pediatric Pulmonology Salary Guide 2026: Complete Earnings Analysis, and Is the Pediatric Pulmonology Certification Worth It? Complete ROI Analysis 2026.
If you want a quick conceptual primer before going deeper, our pieces on Pediatric Pulmonology Certification and What Is Pediatric Pulmonology Certification? are good companions to this article.
Frequently Asked Questions
The American Board of Pediatrics (ABP) issues the certification, and the examination is delivered through Prometric testing centers.
The exam has approximately 200 multiple-choice questions. The passing standard is a scaled score of 180 on a 1-300 scale, which is not a raw percentage correct.
Asthma is the largest published domain at 9%. Common Signs and Symptoms and Core Principles of Pulmonary Diagnosis and Monitoring Techniques follow at 8% each, within a 19-domain outline.
The official indexed regular fee is $2,992, which includes a $750 processing component. Confirm current fee tiers and deadlines on the ABP's subspecialty exam dates and fees page.
The outline effective November 1, 2026 applies to the November 5, 2026 initial-certification examination. The October 2025 subboard approval date is not the effective date, so verify the version on the ABP site.