A bloody pillow, blanket and wipes were found in the room of a baby who died after she was allegedly assaulted by her Irish nanny, investigators say.
Aisling McCarthy Brady, 34, from Quincy, Massachusetts, is alleged to have been the sole carer for the one-year-old US girl on January 14 - her first birthday - when she suffered injuries "consistent with abusive head trauma".
The baby, Rehma Sabir, died two days later in hospital after suffering brain damage.
She was also found to have multiple healing bone fractures.
In court documents, police said they found a blood-stained pillow and blanket in a crib and bloody baby wipes discarded in a nappy pail.
Brady - who is living illegally in America - has been remanded in custody after pleading not guilty to assault and battery on a child causing substantial bodily injury.
However, further charges are anticipated following the conclusion of the final report by the Chief Medical Examiner, the district attorney's office said on its website.
Middlesex District Attorney Gerry Leone said: "This is an extremely troubling case where we allege the defendant violently assaulted a one-year-old child, causing a devastating head injury and broken bones.
"Children are our most vulnerable victims and where, as here, the offender has been entrusted with the care of a child who depends on them, the allegations are all the more egregious."
Irish priest, Kevin Fay, from Lavey, Co Cavan, said the family were "well-known and respected" in the area and that there is no foundation to the charges against Brady.
"Allegations are allegations - there's no foundation to them, no foundation at the moment to any of them," he said.
"Essentially, she comes from a very decent family," he added.
A farmer in Lavey where Brady grew up described her as a very nice girl.
A statement on the District Attorney's website said: "It is alleged that on January 14, the child was in the care of the defendant, her nanny.
"Through their investigation, including interviews with witnesses, police determined that the defendant had sole custody of and contact with the child during the time that she sustained injuries consistent with abusive head trauma."
Court documents filed on Tuesday described how a concerned neighbour heard the infant crying for almost an hour before it changed to "extreme crying", the Associated Press reported.
The woman said she knocked on the front door of the apartment for about 90 seconds, timing the knocks in between the baby's gasping so it would be heard by someone inside, but they were not answered.
Police said: "(The crying) started to slow and settle down before stopping completely."
Rehma's injuries could have happened at any time, Brady's lawyer told the Associated Press.
Immigration authorities said Brady arrived from Ireland in 2002 with a permit to stay for 90 days.
A spokeswoman for Ireland's Department of Foreign Affairs and Trade said: "We are aware of the case and have been in contact with the family.
"We are ready to provide any consular assistance if it is needed."
Rehma's father reportedly comes from London and her mother from Karachi, Pakistan.