A Home Office pathologist has told an inquest she is 'sure' beyond reasonable doubt that baby Poppi Worthington was sexually assaulted before she died.

Dr Alison Armour - a forensic pathologist of 30 years experience - today told Cumbria's senior coroner the little girl had a series of injuries to her bottom that she could only attribute to a penetrative assault.

She added some signs of smothering were also present when she examined the 13-month-old - who died suddenly at her home in Barrow on December 12, 2012.

Dr Armour said it was possible Poppi may have died because of asphyxiation or a cardiac reflex caused by the compression of a nerve pathway.

But she said she could not be certain of either, so the tot's official cause of death remained unascertained, the inquest was told.

However, Dr Armour ruled out any natural cause of death.

She had also told police she suspected Poppi Worthington had been a victim of child abuse when she learned of fractures to the little girl's right leg.

The injury was among a number noted by Dr Alison Armour, a forensic pathologist of 30 years experience, as she conducted a post mortem on the 13-month-old who died five years ago next week.

Other findings, heard as the second week of the inquest into the little girl's death got under way, included bruising and suspected tears to Poppi's bottom which was described as 'dilated' when she died.

Dr Armour explained her examination had been carried out at Manchester Children's Hospital alongside paediatric pathologist Dr Stefanie Bitetti.

Recalling a conversation with police officers, including detective inspector Amanda Sadler, about the circumstances surrounding the death of baby Poppi, Dr Armour said: "I was very concerned regarding the healing fracture of the right tibia and fibula.

"Because where there are fractures - with no history of any accidental trauma - picked up at the time of death this is strongly suspicious of child abuse."

Dr Armour said: "I think it's very important to say there was no natural cause to account for the death of Poppi Worthington."

Gillian Irving QC, representing Poppi's mother, quizzed Dr Armour on potential alternatives to the pathologist's belief that the tot had been assaulted before she died.

Mrs Irving said: "Is the reality of the position five years on that we are never really going to know the cause of death of Poppi Worthington?"

Dr Armour replied: "I know Poppi's mother wants a cause of death.

"But there are some times when we can't give a cause of death.

"I have to be sure, I can't speculate, even though I know it could bring closure to your client."

Other findings from the post mortem examination carried out by Dr Armour included those consistent with reports Poppi had been 'snuffly' on the day before she died.

There was no indication of constipation, she added, despite claims made by Poppi's father Paul Worthington that his daughter had been suffering from this condition before her death.

The proceedings have already heard from her mother, who described how Poppi had been asleep in her cot when she checked on her at about 2am on the morning of her collapse.

She went on to say she was later awoken by the sound of Poppi screaming before Mr Worthington came downstairs to find a new nappy.

Mr Worthington, who gave evidence on Wednesday and Thursday, refused to answer a total of 252 questions surrounding Poppi's final day - referring to his right to refrain from questions that may incriminate him in the future.

In January 2016, High Court judge Mr Justice Jackson, now Lord Justice Jackson, ruled on balance of probability that Poppi had been sexually assaulted by her father in the moments before her death - something he has always denied.

Senior coroner for Cumbria David Roberts has already heard evidence from 26 witnesses as he attempts to ascertain how the tot died.

The inquest will continue for two weeks.