OGDEN — Three-year-old Angelina Costello’s last few months alive were a fog of pain, starvation and extreme psychological abuse, an expert on pediatric development testified Tuesday in the aggravated murder sentencing hearing for the toddler’s parents.

At the conclusion of a week of hearings, 2nd District Judge Michael DiReda will sentence Miller Costello, 30, and Brenda Emile 28, to either 25 years to life in prison or life in prison without the possibility of parole. The defendants took plea bargains to avoid the death penalty.

Tuesday’s hearing focused on what the expert described as the “catastrophic” decline in the last 15 months of the Ogden girl’s life, as chronicled by the parents in phone videos and photos. Angelina died on July 7, 2017.

Dr. Antoinette Laskey, a pediatrics professor at the University of Utah School of Medicine, chief of the Center for Safety and Healthy Families at Primary Children’s Hospital and medical director of the Children’s Justice Centers of Utah, testified as an expert witness for the prosecution.

Prosecutor Letitia Toombs asked Laskey to comment on the difference between photos taken of Angelina in December 2016 and June 2017. “There was hope in December,” Laskey said. “I don’t have any hope seeing that other picture. I’m sure she didn’t either.”

Laskey walked the court through what a child goes through during physical, nutritional and psychological decline.

As Angelina starved, her body used up first the chunky fat of toddlers. “When you consume your body fat, you consume your muscles, to keep your brain going,” Laskey said. “Your body does everything it can to preserve your brain.” Next goes organ fat. Finally, in extreme malnutrition, the body consumes the fat in the brain that wraps around nerve cells. “In terminal malnutrition, people can’t think, can’t do things — the neural connections aren’t working anymore,” Laskey said.

Angelina weighed 14 pounds at death. Laskey said a normal 3-year-old female toddler weighs an average of 31 pounds.

By the end of June 2017, “she absolutely demonstrated terminal malnutrition,” Laskey said. “You literally watch starvation happen before your eyes.” The terminally malnourished are unrecoverable, even with extreme medical intervention, she said.

Toombs asked Laskey to comment on the autopsy results regarding what had happened to Angelina’s mouth and nose.

Cartilage in the right side of Angelina’s nose was “destroyed,” Laskey said. “There had been so much trauma. Had she lived, she would have needed reconstructive surgery. They would have taken pieces of her ear to rebuild her nose.”

Damage to the toddler’s mouth was comprehensive, she said. Broken teeth, lacerations inside her mouth and to the piece of skin that holds the lower lip to the gum, extrema trauma to her lips and tongue. “Talking hurts. Drinking water hurts. Her mouth was a source of pain,” Laskey said.

Beyond all the physical damage, Angelina understood what was happening to her and felt the apparently unrelenting psychological abuse she was undergoing, Laskey said.

“Being offered food and having it withdrawn — she understood taunting,” Laskey said. “Children that experience lack of love and affection and human touch go on to have sociological disorders.”

Angelina as well experienced time as other children do, that some things take “forever,” the doctor said. “Twenty percent of her life, at least, she experienced pain and lack of love and lack of comfort when she was wanting comfort,” she said. The final seven months, as the child’s decline deepened, “that’s an eternity for a child this age. It was forever in terms of Angelina.”

Tuesday’s hearing started more than a half-hour late after Emile refused to be transported from the Weber County Jail to the state courthouse downtown. Jason Widdison, one of Emile’s attorneys, told the judge that she has “struggled with her mental health at the jail.” She wanted to speak to a jail mental health counselor before coming to court, and those services normally are available only at 2 p.m. each day, he said.

“She feels like she is not able to control her emotions now in court,” Widdison said.

Emile arrived later and there were no apparent issues in Tuesday’s hearing. DiReda on Monday admonished Emile against “outbursts” after she shouted at Costello at the other end of the defense table.

In their plea bargain statements, Emile and Costello blamed each other for their daughter’s death.

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