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WHITE PLAINS, N.Y. (Shawn Cohen, The (Westchester County, N.Y.) Journal News -- Five-year-old Garnett Spears' death has been ruled a homicide, sources familiar with the case told the (Westchester County, N.Y.) Journal News, bolstering a criminal investigation that continues to focus on his mother,Lacey Spears.

The Westchester Medical Examiner's ruling was issued April 4 but has not been made public due to the ongoing police probe. The ruling concludes that he died at the hands of someone else and that his death was not an accident or from natural causes. The finding could result in charges such as murder, criminally negligent homicide or manslaughter.

Authorities, who suspect the Chestnut Ridge, N.Y., boy was poisoned with salt, began investigating shortly before Garnett's Jan. 23 death. Doctors at the Westchester Medical Center reported the boy, who had a feeding tube since he was a baby, had suspiciously high levels of sodium in his body. Police later seized a feeding bag, also containing an extreme concentration of sodium, after the 26-year-old Spears tried to have a neighbor get rid of it from her home in the Fellowship Community.

Spears, who is staying with family in Kentucky, has denied she did anything to harm her son, though she recently told a close friend that she expects to be arrested. Her lawyer declined to comment on the ruling.

Spears has portrayed herself on social media as a doting mother struggling to care for a son who'd been in and out of hospitals his entire life.

Authorities believe she may suffer from Munchausen by Proxy, a psychiatric disorder in which a parent harms a child to seek attention and sympathy.

Westchester County and Ramapo police and the Westchester District Attorney's Office have built a case by digging into Spears' 14 months at The Fellowship and her past experiences in Alabama and Florida, reaching out to friends, hospitals and social service agencies while poring over years of medical records.

Police have spoken to members of an attachment parenting group in Spears former home town of Clearwater, Fla., where she'd share tearful stories about raising a sickly son whose father she claimed died in a crash.

Some parents there saw Spears as a supermom for carrying on in the face of such hardship, while others grew skeptical of her stories and concerned when she seemed to disavow Western medicine, instead taking Garnett to a specialist in oriental medicine. One member called that state's Department of Children and Families in 2011 out of concern Spears wasn't getting Garnett proper care, but the state closed its inquiry after confirming the child was seeing doctors.

Detectives also investigated earlier calls to the Department of Human Resources in Alabama, Garnett's birthplace, where his mother would repeatedly bring him to hospitals for reported digestive problems and severe ear infections.

DHR was called once when Garnett had to be airlifted as a baby from one hospital to another after suffering seizures and bleeding from his eyes, nose, mouth and ears. Another time, medical staff at Decatur General Hospital contacted DHR after Spears made questionable claims about her son's inability to keep food down, said a former nurse who has spoken with detectives in New York.

The former nurse, Ginger Dabbs-Anderson, said Decatur General refused Spears' demands to have Garnett fitted for a gastric feeding tube, seeing it as unnecessary. Spears found another place to perform the procedure.

It's not clear why Garnett had a feeding tube for the rest of his life. He did not appear to have any of the conditions — neurological disease, swallowing problems or genetic disorder — that would necessitate one.

Spears told friends her son needed to be tube fed because he'd go days without eating and was a "failure to thrive" case, a diagnosis for children defined by inadequate weight gain. But those same friends saw him routinely eat solid foods. To them, Garnett appeared happy and healthy, a smiley, friendly boy with long blond hair and a gap-toothed smile who had a knack for remembering the names of everyone he met.

Some had difficulty reconciling these shiny images with some of Spears' darker postings on Facebook, Twitter and a blog called "Garnett's Journey."

Spears' updates consumed her Facebook friends as she chronicled her son's final days. Police have examined the postings, comparing them with their own findings based on medical reports, evidence seized from Spears' home, and interviews with people who interacted with her in the period leading up to her son's death.

Just days before taking Garnett to Nyack Hospital, Spears reported on Facebook that he was suffering the flu, though it was seizures that sent him to Nyack Hospital in mid-January. He was airlifted from there to the Westchester Medical Center, where Spears posted pictures of her dying son on life support. It was shortly after the boy's arrival there that police were called, prompting authorities to take their own journey back into Garnett's life and the life of his mother.

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