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A fifth child died Tuesday in a Delaware hospital of wounds from the shootings at an Amish schoolhouse in Lancaster County.
The child taken to Christiana Hospital in Delaware died about 1 a.m. (0500 GMT), state police spokeswoman Linette Quinn said.
The girl was one of seven wounded in the school shooting Monday, America's third in less than a week, in a bucolic area of Lancaster County. Three girls, and the gunman, were killed at the school.
Quinn said the two girls who died in hospitals early Tuesday had suffered "very severe injuries, but the other ones are coming along very well."
A 7-year-old girl died about 4:30 a.m. (0830 GMT) at Penn State Children's Hospital in Hershey, hospital spokeswoman Amy Buehler Stranges said.
"Her parents were with her," Buehler Stranges said. "She was taken off life support and she passed away shortly after."
Charles Carl Roberts IV, apparently spurred by a grudge two decades old, wrote his wife what authorities described as suicide notes, took guns and ammunition and went to a nearby one-room schoolhouse, where he killed three girls on the spot, critically injured seven more, and took his own life, authorities said.
Three girls, ages 8, 10 and 12, were flown to Children's Hospital of Philadelphia, where they were out of surgery but remained in critical condition Tuesday, spokeswoman Peggy Flynn said.
One other victim was taken by helicopter to Christiana Hospital in Delaware, where officials declined to release information.
Roberts, 32, of Bart, was not Amish, did not appear to be targeting the Amish and apparently chose the school because he was bent on killing young girls as a way of "acting out in revenge for something that happened 20 years ago," State police Commissioner Jeffrey B. Miller said.
Two young students were killed at the West Nickel Mines Amish School, along with a female teacher's aide who was slightly older than the students.
"This is a horrendous, horrific incident for the Amish community. They're solid citizens in the community. They're good people. They don't deserve ... no one deserves this," Miller said.
According to investigators, Roberts had finished his milk deliveries before dawn Monday, dropped his own children off at their school bus stop, then at about 10 a.m. pulled up at the Amish school, which had about 25 to 30 students ranging in age from six to 13.
Roberts brought with him supplies necessary for a lengthy siege, including three guns, a stun gun, two knives, a pile of wood and a bag with 600 rounds of ammunition, police said. He also had a change of clothing, toilet paper, bolts and hardware and rolls of clear tape.
He released about 15 boys, a pregnant woman and three women with infants, barred the doors with desks and wood and secured them with nails, bolts and flexible plastic ties. He then made the girls line up along a blackboard and tied their feet together.
The teacher and another adult fled to a nearby farmhouse, and authorities were called at about 10:30 a.m. Miller said Roberts apparently called his wife from a cell phone at around 11 a.m., saying he was taking revenge for an old grudge. Miller declined to say what the grudge could have been.
"It seems as though he wanted to attack young, female victims," Miller said.
Moments later, Roberts told a dispatcher he would open fire on the children if police didn't back away from the building. Within seconds, troopers heard gunfire, and found his body when they were able to get inside.
From the suicide notes and telephone calls, it was clear Roberts was "angry at life, he was angry at God," and co-workers said his mood had darkened in recent days, Miller said.
The names and ages of the dead were not immediately released.
Neighbors and others said they saw no indications of trouble like this brewing.
"They're a fine Christian family. It's ironic and it's heartbreaking," said Lois Fiester, a relative of Roberts who was standing outside the family's modest ranch house.
In a statement released to reporters, Marie Roberts called her husband "loving, supportive and thoughtful."
"He was an exceptional father," she said. "He took the kids to soccer practice and games, played ball in the backyard and took our 7-year-old daughter shopping. He never said no when I asked him to change a diaper."
"Our hearts are broken, our lives are shattered, and we grieve for the innocence and lives that were lost today," Marie Roberts said in a statement read by family spokesman Dwight LeFever. "Above all, please pray for the families who lost children and please pray too for our family and children."
Although the shootings resembled an attack last week at Platte Canyon High School in Bailey, Colorado, where a man took several girls hostage in a school classroom and then killed one of them and himself, Miller said he believed the Pennsylvania attack was not a copycat crime.
"I really believe this was about this individual and what was going on inside his head," he said.
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