Authorities released the cause of death of 5-year-old Elijah Lewis on Monday, saying he died of violence and neglect, including facial and scalp injuries, acute fentanyl intoxication, malnourishment and pressure ulcers.
The autopsy results released by the New Hampshire Attorney General's Office represent the first time authorities have said anything about how Elijah died.
The boy's mother, Danielle Dauphinais, 35, and her boyfriend, Joseph Stapf, 30, were arrested Oct. 17 in New York and remain held without bail on charges of witness tampering and child endangerment. They are both scheduled to return to court in December.
"I didn't think it was this bad, no, I didn't want it to be this bad," said Randy Stewart, Elijah's uncle. "You just kind of hope it was peaceful, and not so barbaric, but that's just not the case."
No one has been charged with causing Elijah's death. Prosecutors have previously said they were waiting for the autopsy results before moving forward with charges in the boy's death.
"This has multiple findings that are all contributing to his death," said Senior Assistant New Hampshire Attorney General Susan Morrell. "If anybody has additional information about Elijah's life in Merrimack or his death, we'd really like them to reach out to law enforcement."
The witness tampering charges allege that Dauphinais and Stapf each asked other people to lie about Elijah and where he was living, knowing that child protection service workers were searching for him. The endangerment charges allege that they violated a duty of care, protection or support for Elijah. Court affidavits supporting the charges were sealed.
Elijah was first reported missing on Oct. 14 by the New Hampshire Division for Youth and Families. He had last been seen "by independent individuals" at his home in Merrimack, New Hampshire, sometime within the previous 30 days.
A state police cadaver dog found Elijah's body buried in a makeshift grave in the woods in Abington, Massachusetts — about 20 miles south of Boston — a little over a week later on Oct. 23.
It's unknown how long the body had been in the woods. Multiple agencies from New Hampshire, Massachusetts, Rhode Island and Maine helped with the search.
"A short life filled with torture that ended tragically," said Northeastern Professor Beth Molnar. "Child abuse and neglect have usually so many other things going on for a family before they get to a point where children are being hurt like like this."
The search shifted to Abington from New Hampshire based on a tip. Previous searches in the area around Elijah's New Hampshire home by helicopter and a nearby lake by boat had turned up nothing.
Plymouth County District Attorney Timothy Cruz and other law enforcement officials shared few details about the case after the body was found, saying they did not want to say anything that would jeopardize getting justice for Elijah.
"Obviously a little boy is gone. Nobody deserves to die this way and we hope to get justice for the little boy," Cruz said at the time.
The attorney general's office said the investigation into Elijah's death "remains active and ongoing" and asked anyone with information to contact police.