Tracy Poston, who was running a day care in the basement of her home at 2935 State Highway 25 at the time of alleged abuse, is accused of causing severe head trauma to the girl.
Testimony at the Cape Girardeau County Courthouse is expected to continue today. A verdict is also expected today.
Poston called 911 on March 28, 2008, after Addison Hobeck, daughter of Kayla and Spencer Hobeck, was having problems breathing and started having seizures.
Testifying for the prosecution Tuesday, Dr. Charles Pancoast of Cape Girardeau said Addison was still having seizures when she arrived at Saint Francis Medical Center. She was given Ativan, he said.
A CT scan taken shortly after Addison's arrival showed the infant had a fresh hemorrhage and an older hemorrhage between the skull and the top of the brain, symptoms consistent with shaken baby syndrome.
Although Pancoast couldn't give an exact time of the head trauma, he said it had to have happened within the previous 48 hours. The head trauma could have been accidental or intentional, Pancoast said, but in an accidental head injury there is typically bruising on the outside of the head.
The final witness called Tuesday, Dr. Ann DiMaio, a pediatrician at Cardinal Glennon Children's Medical Center, said she saw Addison the Monday after the incident. DiMaio is part of a child protection fellowship at the hospital, a team of doctors, nurse practitioners and social workers who specifically handle child abuse cases.
"When I first saw Addison on Monday, her physical exam was within normal limits, but she was irritable," DiMaio said. "On her CAT scan, it showed two subdural bleeds, but there was discussion of a third."
The newest bleed had to have occurred as a result of head trauma within three days of the seizure.
"In my opinion, it happened that day," she said.
An additional examination at Cardinal Glennon showed Addison also had retinal hemorrhaging behind both of her eyes.
"Usually when you have an accidental injury, you have one single injury, not three," DiMaio said.
Addison's mother, Kayla Hobeck, 27, also testified, saying her daughter, now 2 1/2 years old, is growing and developing at a proper rate.
Poston began to care for Addison in November 2007, and Hobeck said she noticed a change in her daughter shortly after Christmas.
"She was very irritable. As a mother I couldn't even hold her. She wasn't consolable," Hobeck said.
Approximately six weeks before the alleged abuse, Hobeck noticed blood on the nipple of her daughter's bottle, which she fed to her just after picking her up from day care. After checking her mouth, a small piece of skin under the top lip of her mouth was torn. The tear, according to medical testimony, can be caused by children hitting their mouth, someone else hitting their mouth or by forced bottle feeding.
Hobeck called Poston, who she said was acting nervous on the phone, to ask her why her daughter's mouth was bleeding. According to Hobeck's testimony, Poston said she didn't know why.