Three-year-old Nia Glassie died from a possible kick or blow to the head administered with "a substantial degree of force", a pathologist told the High Court in Rotorua yesterday.
Such injuries were common when boxers received a blow to the head and fell, Simon Stables said.
He was giving evidence at the trial of Nia's mother, Lisa Kuka, 35, her partner at the time Wiremu Curtis, 18, his brother Michael Curtis, his partner Oriwa Kemp, 18, and Nia's cousin Michael Pearson.
They face charges ranging from murder, manslaughter to assault.
The toddler died of massive bleeding between her skull and brain on August 3, 2007, 12 days after being taken to hospital with a head injury.
Dr Jaco Nel told the court when he spoke with Kuka after examining Nia on admission to Rotorua Hospital on Sunday July 22, she first told him Nia had become sick the previous afternoon after falling from Wiremu's shoulders.
The story then changed, Kuka saying Nia was injured on the Friday evening, Dr Nel said.
The Crown allege the toddler was kicked in the head by brothers Wiremu and Michael Curtis on the Friday.
Nia was seriously ill when she arrived at hospital in a coma, fitting on the left side of her body, the doctor told the court yesterday.
She didn't react to pain, one pupil in her eyes was larger than the other and her arms and legs were stiff.
"The initial signs were that there was something wrong with her brain," Dr Nel said.
Following a CT scan, Nia was transferred to Starship Hospital in Auckland.
"What we saw on the CT scan did not make sense," Dr Nel said.
Nia died 12 days later.
Dr Stables told the court she had a blood clot between her scalp and brain that was 10 to 14 days old when she died.
He performed an autopsy on August 4, the day after she died, noting Nia was 96cm tall and weighed 11.5kg, which was thin for her age and height.
The post mortem showed a large part of the right side of Nia's brain and some of the left side was dead by the time her life support was switched off.
Dr Stables said a thin blood clot covered a large area, about 9 to 10cm in diameter.
Only a fall from a height or blows to the head could have caused such injuries, he said.
A brain infection, acute encephalitis, was ruled out.
Nia was also found to have a number of scars on her body, including a 6cm scar on her abdomen. The trial, now in its third week, is expected to take another two weeks.
