A paediatric consultant doctor has described how staff in an operating theatre gasped when they saw the extent of the injuries on the face and body of a four-year-old boy.
The consultant, Dr Stephen O'Riordan, told the Central Criminal Court he examined the boy after he had surgery for a severe brain injury.
He documented all the bruises on his body and said none of them looked like a normal bruise.
The court also heard injuries to the boy's brain and liver were like those caused by a car accident.
Dr O'Riordan was giving evidence in the trial of a woman charged with the murder of the boy, who was her partner's son.
She has admitted the manslaughter of the boy in 2021 and has also pleaded guilty to two counts of assault. But she has denied murder.
She cannot be named due to legislation protecting the identity of child witnesses in criminal proceedings.
Dr O'Riordan told the court the child at the centre of this case had been transferred to his hospital after being taken from his home by ambulance, for emergency surgery to relieve the pressure on his brain.
He said he went to review him after the surgery, knowing nothing about him. He told the court when he and his team took the drapes away in the operating theatre, they saw all the injuries, and "the whole theatre gasped".
He documented all the bruises and a colleague marked them on a body map, copies of which were given to the jury. He said there was not a single issue that looked like a normal bruise and any of them could be consistent with non-accidental injuries.
In all he documented 17 areas of bruising as well as other injuries.
Dr O'Riordan said bruising on the child’s left elbow and right shoulder were consistent with grab marks left by finger tips.
The child had two black eyes, which the court heard his father claimed had been caused by falling twice in the previous few weeks.
'Classical signs of physical abuse'
The doctor said it was unlikely a four-year-old would get two black eyes from a fall and these injuries were more likely to come from a head injury.
He described the black eyes, along with bruising around the child’s ears as "classical signs of physical abuse".
The doctor described unusual bruises to the front of the boy’s chest as well as bruises to his back. He said these were consistent with the boy landing on his chest or on his back a lot and said they were consistent with non-accidental injuries.
The court also heard the boy had unusual lacerations on his right knee and left elbow as well as very unusual, "very odd" linear bruising under his chin.
Dr O’Riordan said the child had "huge, extensive, very unusual bruising" on his left thigh from his groin to his knee. He said he had never seen anything like it and it was very concerning.
He told the court the injury that probably killed the boy was a hugely extensive injury covering half of his head.
He said it could have been caused by falling from the top bunk of one bed and landing on the metal railing of another bed as claimed by the boy’s father, but with the extent of the other injuries it would be hard to say that. He said the injury to his brain was catastrophic.
Dr O'Riordan gave evidence that a CT scan of the boy's abdomen and pelvis showed a cut to his liver.
He said you would normally get such an injury in a car accident as it would take extreme force to break or split the liver.
The doctor also said a fracture to one of the boy's ribs had begun to heal, meaning the injury had happened a week to ten days beforehand. He said the child's bruising would definitely have been noticed by anyone who met him.
Dr O'Riordan said he was a healthy boy in terms of his size and weight although he noted his fingernails had not been cut and there was dirt underneath them.
When Dr O'Riordan met with the boy's parents separately to give them the bad news about his condition, he said the father explained the boy's black eyes by saying the boy had fallen twice in the previous two weeks.
His mother said the boy was always falling and was dyspraxic, although it was not clear he had ever been diagnosed with dyspraxia.
The doctor said his conclusion was that he had significant concern about physical or intentional abuse in this case.
Earlier an emergency medical consultant said she also had very significant suspicions that the boy's injuries were non-accidental.
Severe brain injury
She said the child had an "acute subdural haematoma" - a very severe brain injury. She said the fall from a bunk bed was not consistent with what she saw on the scan. She said such an injury is normally seen in high velocity road traffic cases or a fall from a big height.
She said she spoke to the child's father who told them the boy had been "grounded" which she said she found a little unusual in a child of that young age.
The consultant said she did not get a satisfactory explanation for the bruising on the child's body from the father.
Once she saw the child's CT scan she said she had very significant anxiety about the cause of his head injury.
Earlier, emergency call taker, Niamh O'Brien told the court she received a call from a man who said his son had fallen from the top bunk of his bed and banged his head.
The man said his son was unresponsive and it was as if he was asleep. He said the fall had happened around an hour previously.
Ms O'Brien said normally if they were dealing with a child who had lost consciousness, they would get a call within a few minutes of the incident happening.
Advanced paramedic, Dan New said when he arrived at the house, the child was lying in the middle of the bedroom floor in the foetal position with his head on a pillow. He did not have a blanket over him.
He noticed the child had bruising on his face and around his eyes. He said from his experience the bruising was at least five days old.
He asked the child’s father about the injuries and was told they were from a previous incident where the child had run into a door.
Boy 'grounded and confined to his bedroom'
Mr New said the child was described to him as bold, and acting up and had been "grounded and confined to his bedroom".
He said, given the clinical severity of the situation, he picked the child up and carried him to the ambulance.
In the ambulance, he assessed the child's pupils which were fixed and dilated and not responding to light.
He said the child's limbs were going stiff, which suggested a head injury. Mr New said he passed on his concerns about the child’s bruising immediately on arrival at the hospital.
Mr New’s colleague, said she saw a woman downstairs in the house. Later in hospital, she asked the father of the child where the bruises came from.
He said the child had been playing soccer earlier in the week and had bruises on his eyes after running into a door the previous day. He said the boy bruised easily.
She asked if she could call the child’s mother but the man said she was not in their lives any more.
The jury has been told the child was living with his father and his father's partner after the mother suffered from mental health issues.
A clinical nurse manager told the court it became clear after a CT scan that the child needed urgent neurosurgery and was to be transferred.
He told the father this and the father again said he would not be contacting the child’s mother. The nurse manager said he asked gardaí to contact the child’s mother. She rang a short time later, hysterical and upset.
Dr Niamh Mitchell, a doctor at the emergency department, said she clearly saw multiple bruises to the child's forehead, eyes, his right arm, both his legs and his inner thighs.
She said she was concerned as she knew from her training that bruises on the inner thighs do not come from "normal play".
The doctor said the bruises were all different colours and it looked as if he had been hit on more than one occasion.
The trial will continue on Monday.
