Poppi Worthington inquest: No 'natural causes' pathologist says

Poppi Worthington was blue and not breathing when she was brought to hospital

There were no natural causes to account for the death of 13-month-old Poppi Worthington at her Cumbria home, a pathologist has told an inquest.

The toddler died suddenly at a house in Barrow, early on 12 December 2012. No-one has ever been prosecuted.

In evidence to an inquest into Poppi's death, Dr Alison Armour said she believed Poppi was sexually assaulted.

Dr Armour also said she had suspected Poppi had been physically abused before she started to examine her body.

Dr Armour said: "I think it is very important to state in this case the autopsy revealed no natural causes to account for Poppi Worthington's death."

She said her conclusions were based on all of her findings which were "in keeping" with Poppi suffering a penetrative injury.

When asked if there was anything she had seen that contradicted her conclusion.

Dr Armour replied: "No."

However, she maintained the "mechanism" of Poppi's death remained "unascertained".

She said it would be wrong to say that a penetrative injury alone caused the death, but she believed it happened and it may have been a contributing factor.

Gillian Irving QC asked Dr Armour: "Is the reality five years on that we really are never going to know the cause of death of Poppi Worthington?"

Dr Armour said: "I do appreciate the mother wants a cause of death, but there are some times when we cannot give a cause of death.

"We have to to be sure, we cannot speculate.

"I know it would bring closure to your client, but I cannot give it, not even on the balance of probabilities.

"There isn't enough for me to sure."

The double bed where Poppi was placed at the time of her collapse

The inquest had heard a detailed account of the various tests done on Poppi during the post-mortem examination carried out by Dr Armour.

The Home Office pathologist said she did find evidence of an "upper respiratory tract infection" which was consistent with Poppi's parents claims she was "a bit snuffly" and had a cold.

She also said she found a "tiny focus" of pneumonia in Poppi's lungs, but it would not account for Poppi's death.

Dr Armour, who has been a Home Office pathologist for 30 years, was asked about bright red blood, known as frank blood, found in Poppi's nose.

She said a cause could not be given for certain, but it can be found in cases of smothering or suffocation.

'Very concerned'

Earlier, Dr Armour told the inquest in Kendal, that an X-ray revealed the child had leg fractures.

Both of Poppi's parents have said they could not explain the fractures and did not believe they were causing her pain.

Counsel for the coroner, Alison Hewitt, asked Dr Armour if she had expressed concern about child abuse before carrying out her post-mortem examination - a comment Det Sgt John Carton claimed he had heard the Home Office pathologist make.

Dr Armour confirmed she made the remark having been "very concerned" by the fractures revealed by a full body X-ray and skeletal survey.

The sofa on the ground floor of the family home where Poppi Worthington was resuscitated

She added: "I think the phrase might have been: 'In cases where there are fractures with no history of accidental trauma and it is picked up at the time of the death of a child, this is strongly suspicious of child abuse'.

Dr Armour carried out the post-mortem examination at the Royal Children's Hospital in Manchester. Poppi weighed 10.7kg and was 81cm tall.

The Cumbria force has been criticised for its handling of the investigation by the police watchdog.

The new inquest was ordered after a seven-minute hearing in 2014 determined Poppi's death was "unascertained".

In 2016, High Court family judge Mr Justice Peter Jackson ruled Poppi was probably sexually assaulted by her father shortly before she died.

Paul Worthington has denied any wrongdoing.