A State pathologist has told the Central Criminal Court that injuries to the brain of a four-year-old boy, whose stepmother is accused of his murder, were consistent with someone shaking the child as well as forcefully striking his head against a hard object like a wall or floor.
Dr Heidi Okkers told the court that these kind of injuries were not caused by falling from a bed, as the child's father initially claimed.
She said tears to the child’s liver would have been caused by direct trauma such as a punch or a kick or a knee to the abdomen.
She said either the head or liver injury could have caused the boy’s death.
The woman on trial has admitted the manslaughter of the boy, who was her partner’s son, 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 Okkers carried out a post-mortem examination on the body of the child in 2021.
She outlined to the court the various different bruises she found all over the child’s body. She said these bruises were of variable ages, distributed over the child’s arms, legs, face, chest, flanks and his back.
She noted that bruises on the child’s right and left thighs were unusual and not typically found on a child.
An area of blue bruising on the child’s left thigh measured 18.5 centimetres by ten centimetres at its widest point.
She said a pattern of bruises on one of the child’s shoulders was consistent with finger prints.
The State pathologist told the court the pattern of bruising on the child’s body suggested handling of the child and the bruises suggested nonaccidental injuries.
She said the bruising was not indicative of a single fall.
Dr Okkers said the type of injuries she saw to the child’s brain were usually seen in road traffic collisions or if there had been an assault.
The brain had shifted from one side of the skull to the other, which she said would be caused by significant force.
She said such injuries in children were caused by shaking or punching or hitting in addition to the child falling or being thrown to the ground or against a wall.
She said you did not get these kinds of severe brain injuries from falling off furniture or a bed. Dr Okkers said quite significant force and speed would be needed.
Dr Okkers was also asked about blood in the child’s abdomen as well as tears to the front and back of his liver.
She said the injury to the child’s liver would have to be caused by a direct trauma, like a punch, kick or knee. She said a fall would not cause such an injury.
The child’s father had told doctors that his son had fallen from a bunk bed which was 1.5 metres high.
But Dr Okkers said significant brain trauma from a bunk bed fall was very rare.
She said either the traumatic head injury or the trauma to the child’s abdomen could have caused his death.
She said the injury to his liver would not have been obvious externally but would have caused pain and the child would have been crying and complaining.
Dr Okkers was asked by defence counsel Michael Lynn if some of the bruising to the boy’s body could have been caused by playing on a trampoline.
She said some, such as normal bruising to a child’s knees, shins or forearms could have been caused in such a manner but not the bruising to the boy’s chest, abdomen, back or thighs.
She told the court the boy’s stomach was empty suggesting there had been no food intake.
The court also heard that gardaí seized a number of items of pain relief for children from the bedroom where the boy had been sleeping - including arnica ointment – which is used for bruises – a hot and cold pack for injuries, and Nurofen for children.
Gardaí also found soiled children’s underwear, socks and a bedsheet in a mound of laundry behind the door of the master bedroom in the house.
Bloody bandages and steri-strips were found in a bin in the back garden the court heard.
Gardaí also seized an electronic tablet from the living room and they retrieved CCTV footage from a neighbour’s house.
The trial will continue tomorrow afternoon.
