So you strangled the kittens to avoid blood. That's horrific.
I think I know what actually happened. Or rather, have some pretty good ideas.
1: They got sick, and died. Possibly originally from one of them having an eye infection because kittens can get that, and then it spread to the other kittens because Emily didn't do anything to treat the first one, and then they all died from it.
Even if she did take them to a vet, she probably didn't do the home treatment because tbh it is gross, and her sociopathic mind probably didn't let her "turn on her empathy" to look past that, and help them regardless. She might've even been too dumb to do the home treatment in the first place.
2: She brought them into bed to sleep with at night, and then accidentally rolled over onto them, and crushed/suffocated them while she was sleeping. She also might've just accidentally sat on them.
3: She killed them while trying to play with them. Now how does that happen? Remember that Emily has the mind of a young child. Not only that, but a young child who struggles with empathy. As someone who grew up around a fuckton of a cats, and has a bunch of young nieces, and nephews who are currently doing the same, I can assure that young children often treat kittens like toys, and not like actual living things. Simply put, they'll be too rough with them, play games with them like they would with stuffed animals, and the kittens will get hurt.
However, once this happens, the kids will realize what they've done because the kitten will be meowing in pain, and they'll stop. Emily, on the other hand, who is emotionally stunted, and stupid af, and has willingly admitted to being able to turn off her empathy, probably didn't, and just moved onto the next one when the previous one was too hurt to be fun anymore to her, and the cycle repeated until to her all the kittens were "broken", and she didn't want to play with them anymore, and then they all died from their injuries, and subsequent neglect.