Tania Clarence, 42, from Thetford Road, New Malden south-west London, looked pale and fragile as she appeared via video-link at the Old Bailey, accused of killing her three-year-old twin sons, Ben and Max, and four-year-old daughter, Olivia, at their home.
Wearing black jeans and a black zip-up fleece jumper, her voice shook with emotion as she confirmed her name in a thick South African accent.
She sat in a green-curtained room at HMP Bronzefield in Surrey to hear if she would be granted bail.
Her investment banker husband, Gary, 43, was supported by friends as he sat in the public gallery during the bail hearing. Mrs Clarence is accused of three counts of murdering a child aged over one-year-old between April 20 and April 23 this year. All three youngsters suffered from type 2 spinal muscular atrophy.
Also known as floppy baby syndrome, the genetic condition leaves children with little control of their movements and can drastically shorten life expectancy.
Judge Brian Barker, the Recorder of London, allowed Mrs Clarence to be released from prison, and instead remanded to a secure hospital under the Mental Health Act. A plea and case management hearing will be held at the Old Bailey on July 15.