Larry kept his head down during the hearing, saying only "Yes, ma'am," when Judge the judge asked him questions.
The judge also ordered Larry transferred to the county jail's medical unit for mental health treatment. Larry's attorney, Assistant Public Defender Julie Koehler, said he needed treatment and had been under a doctor's care for mental health problems for eight years.
Koehler described Larry as "very, very emotional and upset" and said he kept his head down during the hearing because he was crying.
Larry was arrested after the Wednesday morning shootings on Chicago's southwest side and charged Thursday night with four counts of first-degree murder, four counts of attempted first-degree murder and two counts of intentional homicide of an unborn child. Along with his wife, his 16-year-old niece was pregnant.
Larry told police after his arrest that he heard voices encouraging him to kill his family and was sorry he had run out of bullets, a person close to the investigation told The Associated Press. The person spoke on condition of anonymity because he was not authorized to discuss the investigation.
The Cook County Medical Examiner's office has identified the shooting victims as Tawanda Thompson, her 7-month-old son, Jahod Larry, high school student Keyshai Fields, 16, and 3-year-old Keleasha Larry. Both young women were pregnant.
A 12-year-old girl escaped from the house and called police.
Larry was arrested shortly after the shootings.
The Associated Press contributed to this report.