The English designated child protection consultant paediatrician, Dr. Katherine Ward, said she'd reached that conclusion "having considered the investigation, witness statements and medical reports" into the death of 15-month-old Millie from head injuries on December 11, 2009.
Millie's 27-year-old mother, Rachael Martin, from Main Street, Kesh, and her former lover, 33-year-old Barry McCarney, from Woodview Crescent, Trillick, face charges arising out of her death.
Martin denies wilfully neglecting and allowing the death of her daughter, while McCarney denies murdering and sexually and physically abusing her.
The jury of nine men and three women heard that Rachael Martin had once joked that ghosts may have been responsible for the repeated injuries to her baby daughter.
However, Martin's mother Mrs. Margaret Graham claimed, the remark had been made only as "a figure of speech".
Mrs. Graham was being cross-examined for a second day by McCarney's defence QC Elis McDermott, whose final question to the grandmother was, if she had heard her daughter "Rachael say that ghosts may have caused these injuries to Millie".
While agreeing that "there was jokes", she quickly explained that, "in a figure of speech, Rachael joked to me that may well be the case".
However, Dr. Ward was unequivocal in her opinion as to what had happened to Millie, who, in her words, had had "a very uneventful medical history and was being attended to appropriately ..... up until September 2009".
The court has already heard it was around this time, her first birthday, that she was first allegedly injured.
Dr. Ward told the court that "having considered the investigation, witness statements, and medical reports, I concluded that there is clear evidence that Millie was the subject of repeated and severe inflicted injury, which led to multiple injuries, including a fatal head injury".
During her evidence she claimed that many of the multiple sites of injury to Millie, were indicative to her, of non-accidental injuries.
With regard to the head injury which eventually lead to Millie's death, Dr. Ward said that the large bruising it left, would have been "associated with a memorable event, which would not have gone unnoticed", and that there was nothing to suggest in the child's history it was non-accidental.
The paediatrician added: "In my opinion this was the result of a blow from behind" and may have been caused by a "forceful blow to the child's head by a moving object, or the moving head hitting or coming into impact with an object".
However, the doctor admitted that forensically it was "difficult" to say which had indeed caused the fatal injury.
Earlier Ms McDermott had questioned Mrs. Graham about alleged discrepancies between what she'd said in evidence to the court and to police, and what she told a social worker.
Initially Mrs. Graham claimed she had "no recollection" of any meetings following Millie's death, and asked of Ms McDermott: "When was this?"
She later added: "I can't recall speaking to the Social Services to be honest with you."
However, after being shown some "documentation", Ms McDermott suggested there had been two separate meetings with social workers "about the events leading up to Millie's death".
Mrs. Graham seemed to remember something, while claiming that the meetings were not about "Millie though", and added that she did not really "remember much about it to be honest".
Ms McDermott then put it to her, she had told a social worker she did not "observe any injuries on Millie's body and you had no concerns about her presentation or her behaviour" the November weekend she'd looked after Millie.
Partially accepting the suggestion, she also accepted telling police and the court she had seen bruising on the infant, and that she was concerned for her granddaughter that weekend.
Mrs. Graham also agreed that when she asked her daughter, Rachael, about the bruising, she got "annoyed" telling her mother "do you think I did it?" before "leaving the room".
She also told a social worker she had not wanted to further annoy Rachael, so had said nothing about marks to Millie's private parts.
However, Mrs. Graham explained Rachael's reaction in terms of any normal "mother - daughter relationship" and while she may have been "stroppy" with her, she could not say how she would have reacted with others outside.
Later under cross-examination by her daughter's QC John McCrudden, Mrs. Graham described her daughter as an "excellent ... caring" mum who often "sought her advice".
She also told the lawyer that it "never crossed her mind" that Millie had fractured ribs, and also agreed she'd said to another social worker that she "never thought in my heart of hearts that he (McCarney) would have hurt her".
Mrs. Graham told Mr. McCrudden that her daughter never tried to "disguise by make-up" nor had she attempted to hide anything about Millie and was always open with her.
The case continues.