Most blueprint updates shuffle percentages around. A content area gains two points, another loses three, and the practical effect on your studying is close to zero.
The new Pediatrics End of Rotation blueprint, publishing July 27, 2026, is not that.
PAEA added an entire content area that did not previously exist: Growth and Development, weighted at 10%.
That is ten of your scored questions testing material the old blueprint never explicitly asked about. Not ten questions reweighted from somewhere else — ten questions on a subject that was not on the map.
If you study from an older resource, you will walk in blind to a tenth of the exam.
A note on the numbers: each EOR exam contains 120 items, of which 100 are scored and 20 are unscored pretest questions. PAEA’s blueprints are expressed against those 100 scored questions, so the percentages below translate directly into scored questions.
PAEA had to fund the new content area by taking weight from elsewhere. The crosswalk shows exactly where:
| Content area | Legacy | New |
|---|---|---|
| Dermatology → Dermatologic | 15% | 10% |
| ENOT/Ophthalmology → EENOT | 15% | 12% |
| Infectious diseases | 12% | 10% |
| Cardiovascular | 10% | 8% |
| Neurology/developmental + Psychiatry/behavioral | 6% + 6% | 8% (merged) |
| Endocrinology → Endocrine | 3% | 5% |
| Hematology → Hematologic | 3% | 5% |
| Urology/renal → Renal/genitourinary | 3% | 5% |
| Growth and development | — | 10% |
Dermatology took the biggest cut, dropping five points. Neurology and Psychiatry were merged into a single area and lost four points between them.
The message is hard to miss: PAEA decided that well-child care deserves more of the Pediatrics exam than rashes do.
PAEA’s blueprint does not just tell you how many Growth and Development questions there are. It tells you what task each one performs. Here is the actual distribution of those ten scored questions:
| Task area | Questions |
|---|---|
| History & Physical | 3 |
| Health Maintenance | 3 |
| Diagnosis | 2 |
| Clinical Intervention | 1 |
| Professional Practice | 1 |
| Diagnostic Studies | 0 |
| Clinical Therapeutics | 0 |
| Scientific Concepts | 0 |
Read that again, because it should completely reshape how you prepare.
Six of the ten questions are History & Physical plus Health Maintenance. And there are zero Diagnostic Studies questions, zero Clinical Therapeutics questions, and zero Scientific Concepts questions.
There is no lab to order. There is no drug to pick. There is no mechanism to explain.
Growth and Development is testing whether you know what normal looks like, when to worry, and what to counsel — and essentially nothing else. Students who prepare for this content area by memorizing pathology will be preparing for questions PAEA is not asking.
Developmental milestones, cold. Gross motor, fine motor, language, and social-emotional, across infancy through adolescence. Not approximately — precisely. The difference between a 9-month-old and a 12-month-old is exam-relevant, and History & Physical being the largest task bucket means you will be handed a description and asked whether it fits.
Red flags for developmental delay. Loss of previously acquired skills is the one to know above all others — regression is never normal and always warrants workup. Also: not babbling by 12 months, no single words by 16 months, no two-word phrases by 24 months, and any loss of language or social skill at any age.
Growth curves and how to read them. Plotting, percentiles, and — more importantly — velocity. A child tracking steadily along the 5th percentile is usually fine. A child crossing percentile lines downward is not. Know the difference between short stature and failure to thrive, and know that weight falls before length, which falls before head circumference.
Anticipatory guidance by age. This is what Health Maintenance means, and it is three of your ten questions. Safe sleep. Car seat progression. Introduction of solids. Screen time. Firearm storage. Adolescent driving. Sports safety. These are the recommendations that get skimmed in review books and asked directly on the exam.
Puberty and its normal sequence. In boys, testicular enlargement comes first and the growth spurt comes late. In girls, the growth spurt comes early, before menarche. Tanner staging. Knowing the normal sequence is what lets you recognize constitutional delay — a normal variant — versus something pathologic.
Screening schedules. Developmental screening, autism screening, lead, anemia, vision, hearing, and depression screening in adolescents. Know what gets screened, and when.
Which blueprint is your program testing you on?
The legacy Pediatrics exam remains available through July 2027. Your program decides when to transition, not you, and PAEA recommends that an entire cohort test on the same blueprint for consistency.
This matters more for Pediatrics than for any other rotation, because the gap between the two versions is the largest. If you are on the legacy exam, Growth and Development is not a scored content area and you should not spend a tenth of your study time there. If you are on the new one, it is ten questions.
Ask your clinical coordinator. Get an actual answer. Do not infer it from your exam date.
Preparing for your Pediatrics EOR? Our End of Rotation review courses are aligned to the current PAEA blueprints, with practice questions built to the same content-area and task-area weighting you will face on exam day.
Jeremy Boroff, MPAS, PA-C is a practicing Emergency Medicine Physician Assistant with 24 years of clinical experience and more than 20 years as an APC Director of an emergency department. He is the author of Emergency Medicine End of Rotation (EOR) Exam Review and Test Prep, Ace the Psychiatry & Behavioral Health EOR, and Gynecologic, Sexual, and Reproductive Health End of Rotation (EOR) Exam Review. He founded CME Review Courses and created the PAtopia app to help PA students prepare for the PACKRAT, all seven End of Rotation exams, the End of Curriculum exam, and the PANCE.
All blueprint percentages in this article are taken from PAEA’s official 2025 Blueprint Crosswalk documents, published September 2025. PAtopia and CME Review Courses are not sponsored by, endorsed by, or affiliated with PAEA or NCCPA. End of Rotation™, PACKRAT®, and End of Curriculum™ are trademarks of the Physician Assistant Education Association.
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