Foos Hashi, 70, who was joined by a public defender and an interpreter, waived a formal arraignment and did not enter a plea.
Milpitas police say the incident happened Monday afternoon. Officers responded to a 911 call after the victim's aunt came home from picking up her children from school and found the boy unresponsive. He died about an hour later at a nearby hospital.
RELATED: Grandmother arrested after 3-year-old boy dies from strangulation
"There's nothing that we can do to bring him back, but we're going to do everything we can to ensure that the person responsible is held accountable," said Deputy District Attorney Luis Ramos.
New documents obtained by KGO-TV revealed that the toddler, identified as Ayub, had been sick and taking medication in the days leading up to his death.
#TODAY: 70 y.o. Foos Hashi of Milpitas made her first court appearance at the Santa Clara County Hall of Justice this afternoon. No plea was entered. She’ll return to court on May 8th. No bail allowed. #ABC7Now pic.twitter.com/m97kAk2TSH— Chris Nguyen (@ChrisNguyenABC7) April 19, 2019
Hashi told family members the boy had vomited, so she laid him down to rest.
However, the District Attorney's office says the victim's 4-year-old cousin witnessed the grandmother choking him.
"The 4-year-old has revealed that she watched the grandmother strangle the child and throw him down on the floor," said Ramos. " At this point, the evidence seems to indicate that the grandma was the sole person responsible for the crime."
Police took Hashi into custody Wednesday night and booked her into the county jail.
More than a dozen friends and family members showed up to the hearing. Hashi did not enter a plea and bail was denied.
Hashi was charged with multiple counts, including first-degree murder. She faces 25 years to life in prison and is due back in court on May 8.