A 20-month-old foster child died after he suffered a head injury which likely led to brain swelling and deteriorating consciousness, a paediatrician told Dubbo Local Court this week.
Before his heart stopped beating at a property outside Dubbo, the toddler was being cared for by a woman who police allege murdered him sometime during the night between March 22 and March 23 in 2015.
In January 2018 the woman, whose name was suppressed by the court, was arrested in Geurie and charged with murder. She sat stony-faced and was fidgeting with her fingers during a hearing to determine if her case would go to trial in the Supreme Court.
The court heard the dead child had a broken femur, injuries to his bottom area and extensive bruising to his abdomen and face.
According to documents presented to the court, the now 41-year-old foster mother was allegedly heard saying "they're going to think I bashed him" and "am I going to get in trouble for this" when she called triple zero for help at 5.17am on March 23.
A paramedic who responded to the call said "[the child's] complexion was pale, he had bruising across his forehead and discolouration around both eyes which did not look normal". Another paramedic said bruises covered a majority of the child's forehead.
Despite multiple attempts to revive the child, he was pronounced dead at 7.30am.
Numerous sources told police the child was sick, vomited and had a high temperature in the days leading up to his death, court documents revealed. The woman also allegedly told acquaintances the child was "clumsy" and "fell over a lot" before he died.
The night before the toddler's life ended, he and his foster mother went to a nearby property to watch a football match. Witnesses said the child was trying to sing and appeared to be in good health.
When questioned by police the woman allegedly said the child lashed out at her and harmed himself when she was trying to bath him the night before he died.
A witness told police they observed the woman sitting on a toilet during the night, while the child was standing naked in the bath tub. According to court documents, the woman allegedly told the witness not to mention "the bath" when police were asking questions after the child died.
The forensic pathologist who carried out an autopsy on the child, Professor Tim Lyons, described the child's injuries as "inconsistent with being accidental in nature".
"I am of the opinion there had been a number of applications of blunt force trauma to the head," he said.
In court, a specialist from the Children's Hospital at Westmead Child Protection Unit, who reviewed the autopsy, said the presence of fluid around the child's brain was an indicator of traumatic brain injury.
"The fracture of the femur... if that had been an isolated incident, I don't think that would have caused death," Dr Susan Marks said.
"The more prominent cause of death would have been head injury."
Neuropathologist Associate Professor Michael Buckland told the court swelling on the child's brain could have been caused by a traumatic injury or a lack of oxygen going to the brain.
"I didn't see any developmental abnormalities," he said.
The woman's legal representative said there is no direct evidence she caused any injury to the child.
Magistrate Lisa Stapleton adjourned the case to July 2 and the woman is yet to enter a plea.
She remains behind bars at a maximum security correctional centre in Silverwater with bail refused.