Murder trial told hospital doctors 'gasped' at extent of boy's injuries after admission

Dr Stephen O'Riordan, a consultant paediatrician, said the child had significant bruises "from head to toe" which were consistent with physical abuse or non-accidental injuries.

He documented 17 areas of bruising or injury to both eyes, the ears, arms, legs and back. The "black eyes," combined with bruises around both ears are "classic signs of physical abuse," he said.

A consultant intensive care doctor who gave evidence today said the injuries the boy suffered would usually be associated with a crash where a car hits a wall or a fall from a "very significant height".

Anne Rowland SC, for the Director of Public Prosecutions, said in her opening statement this week that it is the State's case that the boy's father and stepmother had kept the boy out of sight of other family members for several days due to bruises he had suffered from a series of assaults. She said a pathologist will say that the child died due to a traumatic head injury in association with blunt force trauma to the stomach. 

The brain injury was caused by shaking combined with contact with a flat surface, Ms Rowland said. 

Dr O'Riordan said the child's father had said the black eyes were the result of two falls over the previous two weeks. Dr O'Riordan said: "Any fall in a four-year-old child that I would see regularly would never have two black eyes. One or the other, but having two would more likely be from a head injury."

There were possible "grab marks" on one shoulder and to the left elbow and multiple bruises on the back and chest suggesting the boy was "landing on his chest or back a lot, which is consistent with non-accidental injury".

The most significant, he said, was a "hugely extensive injury" to the back of the head which the father had said was caused by a fall from a top bunk onto a metal bed. Dr O'Riordan said the injury could "potentially" be caused by such a fall, but it would be hard to say given the extent of the other injuries.

A laceration to the boy's liver, Dr O'Riordan said, would have been caused by "extreme force" and would normally be associated with a car accident. X-rays carried out by another paediatrician showed the boy had previously suffered a fractured rib that was starting to heal. The healing would suggest that the injury was seven to ten days old, Dr O'Riordan said.

This was "significant", the doctor said, because it suggested the boy suffered trauma at a different time.

Dr O'Riordan said the number of unexplained injuries left him with a "significant concern" about physical or intentional abuse against the child.

Emergency call taker Niamh O'Brien told Ms Rowland that she received a call at 12.46pm on March 13, 2021 from a man saying his son had fallen out of bed, banged his head and was unresponsive.

The caller described a "large bump" on the back of the child's head, slightly smaller than a golf ball, and while he was unconscious, he was breathing. He said the child had fallen about one hour before the call and went unconscious about 20 minutes later. The man said he thought the child was "just sleeping" until he tried to wake him but found the boy couldn't be roused.

Ms O'Brien said a call to emergency services would usually be "quite immediate" or "within minutes" in cases where children have lost consciousness due to a fall.

An advanced paramedic who was first on the scene told Ms Rowland he met the child's father halfway up the stairs. Inside an upstairs bedroom, he saw a child lying on his side on the floor in the foetal position with his head resting on a pillow.

The paramedic noted "yellowish" bruising, suggesting older injuries, and a bump or haematoma on the back of the head. When asked about the older bruises, the father said the child had previously run into a door.

The father also said the child had been "bold, acting up, behaving badly and was grounded and confined to his bedroom," the paramedic said. The paramedic said he didn't want to waste any time so he took the boy in his arms and carried him to the ambulance.

The child's pupils did not react to light, indicating a significant head injury, he said. He also showed signs of "posturing", whereby the limbs become extended and stiff, further suggesting a head injury and swelling or pressure on the brain. The paramedic put a collar on the child to restrict spine movement and called ahead for the paediatric resuscitation room at a nearby hospital to be prepared.

A paramedic supervisor who was with the advanced paramedic said she also observed bruises to the boy's eyes, face, torso and to both legs. He was "very, very pale, almost white" and was not moving.

The child's father told the paramedic that the boy had fallen from the top bunk of the bed about an hour earlier. 

The father also said that the bruises on the child's face were caused when he had been playing soccer earlier in the week. He said the child "bruises easily" and when asked about bruising around the child's eyes, he said the boy "ran into a door the day before or two days before".

The paramedics reported concerns they had about the child's welfare when they arrived at the hospital. 

A nurse at the hospital told Ms Rowland that the child's father told him that the child fell twice that day, with one hour between each fall. He said he called 999 after the second fall.

A CT scan indicated the child needed immediate neurosurgery so it was decided he would be transferred to another hospital. The father told the nurse that there was "no contact" with the child's mother, that they had a "troubled relationship" and that he would not be contacting her.

The nurse called gardai and asked them to contact the mother. 30 minutes later, the child's mother called the hospital. The nurse spoke to her and told her which hospital the child was being taken to. "She was hysterical on the phone, as you would be. She was upset, very upset," the nurse said.

Dr Niamh Mitchell, a specialist in emergency medicine, was working as a registrar at the time. She said the child had the most serious type of head injury. Dr Mitchell inserted a urinary catheter and as she did so, she noted multiple bruises on the child's forehead, both eyes, his right arm and significant bruises on both legs including on the inner thighs. 

The bruises were of different colours, she said, indicating they had been caused at different times. She said: "It looked like he had been hit on more than one occasion because of the different colours. It didn't look like something you would get from normal play. The inside of the legs is not something you would injure in normal play."

A consultant intensive care consultant who treated the child said the dilated and unresponsive pupils indicated a severe traumatic brain injury. She said she did not receive a satisfactory explanation of the bruises of different ages from the child's father, which gave her cause for concern. She said the father told her that the boy had been "grounded", which she found "a little unusual for a child of that young age".

She said she has received training in how to recognise non-accidental injuries. Bruises of different ages with a non-satisfactory explanation from the primary caregiver gave rise to concerns, she said.

The injury to the brain, she said, was not consistent with a fall from a bunk bed. Such a fall could cause injury and bleeding to the outside of the skull but the CT scan in this case indicated a "very significant" injury to the brain. The 'subdural' injuries shown on the scan would be associated with a car accident where the vehicle hit a wall or a fall from a "very significant height", she said.

The trial continues in front of Mr Justice Paul McDermott and a jury of four women and eight men.