In regard to the Jan. 17 article "Va. Girl's Death Underscores Need for Home Day Care Regulation" {Metro}, readers should know that the American Academy of Pediatrics and the American Public Health Association are collaborating to develop national health and safety performance standards for out-of-home child care. These performance standards will serve as a national reference code for program compliance, assessment of training and technical assistance and promotion of improved quality of child care. This project is funded by the Bureau of Maternal and Child Health and Resource Development, Department of Health and Human Services, and will be completed by June 30, 1990.

The lack of available child-care facilities along with the inadequacy or absence of appropriate regulations leave parents with few acceptable alternatives and children without an assurance of protection. Although reports of tragic incidents in child-care settings such as this article describe are becoming more frequent, there is very little epidemiological documentation about the incidence of disease and injury in these care settings. However, of the common incidents -- such as transportation injuries from inadequate restraints in vehicles, burns, falls and respiratory and enteric illnesses -- many are preventable.

Current child-care regulations are often inadequate. A recent survey by Work/Family Directions of state child-care regulations reveals infant-to-staff ratios in child-care centers as high as 8 to 1. Hand washing, one of the most basic, inexpensive and effective means of controlling communicable diseases, is not required in child-care centers in some states.

The performance standards being developed will serve as a benchmark to evaluate family day-care homes, group homes and child centers in the areas of environmental quality, prevention and control of infectious diseases, injury prevention and control, general health, nutrition, prevention and management of child abuse, staff health, children with special needs, health concerns related to social environment and child development, and organization and administration of the health component.

By addressing the issue of quality of services, performance standards can strengthen and increase the participation of health and child-care professionals in out-of-home child-care programs. And it can allow parents to become better informed "shoppers and users" of child care. DEBRA HAWKS Project Director American Public Health Association Washington