A doctor who examined the body of Poppi Worthington “strongly” suspected the toddler had been sexually abused before she died, an inquest has heard.
Home Office pathologist Alison Armour said police told her before she carried out the post-mortem that the 13-month-old had suffered leg fractures, Kendal Coroner’s Court heard.
Dr Armour told the court further examinations showed Poppi had reddened inner thighs and bruising, as well as “a little liquid blood” in her stomach and in and around her nose.
She said she immediately raised concerns to police that the child’s injuries may have been caused by abuse.
Poppi, who was otherwise healthy, collapsed at her home in Barrow-on-Furness, Cumbria, on 11 December 2012, and was pronounced dead in hospital the following day.
No one has ever been prosecuted over her death and the cause remains “unascertained”. However, during family court proceedings in 2016, it was ruled a High Court judge that the toddler’s father, Paul Worthington, 49, probably sexually assaulted her.
Mr Worthington, who denies any wrongdoing, gave evidence at the inquest – the second into Poppi’s death – but refused to answer more than 250 questions.
During Dr Armour’s evidence, Alison Hewitt, counsel to the inquest, asked her: “Do you recall whether you expressed any view as to whether this is a case of child abuse?”
The pathologist, who has 30 years experience, said there was no record of any accident to explain the leg injuries, which were only picked up after Poppi’s death.
She said: “I was very concerned about the healing fractures to the right tibia and fibula and my remarks were made to that effect – ‘this is strongly suspicious of child abuse’.”
Her examination also found bruising to the back of Poppi’s throat and internal and external injuries to the rectum area.
Dr Armour told the court that blood found in and around Poppi’s nose was “a very concerning feature” and that bleeding from the nose is “a sign of acute upper airways obstruction” seen in cases of suffocation.
Constipation was initially believed to have contributed to Poppi’s death, but Dr Armour said her injuries were inconsistent.
“They’re consistent with penetration,” she told the court.
The pathologist said she had seen similar injuries twice before in cases involving children, who in both cases were “victims of a violent sexual assault”.
Cumbria Police has been criticised for its handling of the investigation by the Independent Police Complaints Commission.
The second inquest was ordered after the first hearing, held by a different coroner, lasted just seven minutes and was accused of being shrouded in secrecy.
Poppi’s DNA was also found on Mr Worthington’s penis, which he said was from holding her and then going to the toilet.
The hearing continues.