Smithfield, N.C. — A forensic pediatrician who testified Thursday that a Johnston County woman ritualistically tortured the six children entrusted to her care said she believes that abuse led to the death of adopted son.

"In my opinion, Sean Paddock, a 4-year-old child, was the victim of very severe child abuse," Dr. Sharon Cooper said. "He was the victim of ritualistic abuse. He was the victim of sadistic abuse. He was the victim of torture, and he was a child who died from fatal child homicide."

Lynn Paddock, 47, is on trial for first-degree murder in Sean's Feb. 26, 2006, death. Prosecutors have argued that Paddock wrapped him tightly in a blanket and that he suffocated.

"On the night that he died, he had external constrictions around his chest and he could not breathe adequately," Cooper said.

Cooper, who prosecutors said Friday is the state's last witness, said Sean had experienced, in the past, anxiety from having his mouth taped with duct tape and being forced to sit or lie underneath furniture, including a couch and a bed in the attic – where he was sleeping the nights before he died.

Defense attorneys, who expect to begin their case on Monday, say the boy's death was accidental and that Paddock's actions were discipline, not abuse.

Cooper also testified about the alleged abuse of the five surviving Paddock children – two of whom are Sean's biological siblings – saying they were forced to eat vomit and had pressure sores on their bodies from where they were confined to their beds.

They were also made to drink lots of water and had to wear diapers, she said, and would go for periods without food.

"All of these children, over a period of time, demonstrated they had been victims of starvation," Cooper said, adding that when they left the Paddocks' care, they gained significant weight, putting them back at healthy weights.

One child, she testified, was the victim of beatings and isolation and was "entombed" in pillows and blankets with a bookshelf on top of her. Another was repeatedly beaten and made to sit under a table, Cooper said.