Three caretakers of a 4-year-old Missouri girl were arrested after the girl was brought to a hospital unresponsive and then lifeflighted to a St. Louis hospital 200 miles away.

James Calhoun Lamb, Aireal Brishay Cole, and Derrick Eugene Barnby were charged with multiple counts of  child abuse, KMZU reported.

Lamb, the girl’s father, reportedly told police that the little girl fell down the stairs a week before she was brought to the hospital  on December 11. Doctors found she had multiple bruises and other physical injuries.

A probable cause affidavit says that Lamb reported the girl in good general health with no issues, other than “getting up in the night and wandering downstairs and getting into things.”

On December 6, he said, the three caregivers noticed that the girl was “acting odd and as if she was in pain” and that when they asked what happened, she told them she fell down the stairs in the middle of the night two nights earlier. Lamb said he gave her bath and checked for injuries, saw the bruising, but didn’t think it was severe. He contacted his mother, a “medical professional,” who tol them to monitor her and give her over the counter pain medications.

On December 11, Cole brought the girl to the hospital because she was still experiencing pain. The doctor who checked her there “noted signs of abuse and neglect.”

In a report, the doctor wrote that she “is a 4 1/2 year-old child with brain injury, altered mental status, ICH, bruising, extensive dental (cavities), and malnutrition.” The doctor said a fall down the stairs would not normally cause the kind of extensive head trauma the girl experienced, nor would a brain injury take a week to manifest.

The doctor further said the girl “is significantly underweight and fulfills the criteria of severe malnutrition.”

In addition to the 4 year old girl, child welfare employees removed an 18-month-old girl from the home who had “severe diaper rash that was consistent with neglect.”

Lamb told detectives that he and Barnby both had anger issues but had never taken their anger out on the children.

Barnby, Lamb, and Cole are not listed in online Adair County jail records, so it’s not clear if they are still behind bars or have been released. The condition of the older girl is unknown after she was taken to St. Louis for treatment.

For the latest true crime and justice news, subscribe to the ‘Crime Stories with Nancy Grace’ podcast.

[Featured image: James Calhoun Lamb, Aireal Brishay Cole, and Derrick Eugene Barnby/Adair County Sheriff’s Office]