There were no natural causes to account for Poppi Worthington’s death, the pathologist who examined the 13-month-old has told an inquest.

The otherwise healthy toddler collapsed at home in Barrow, Cumbria, and was pronounced dead in hospital an hour later.

Dr Alison Armour told Kendal coroner’s court that she suspected child abuse after examining Poppi’s body.

Her father, Paul Worthington, 49, was ruled to have probably sexually assaulted her, according to a judge during earlier family court proceedings.

Cumbria police detectives, who dismissed Armour’s initial view as “rash”, botched their investigation which meant vital evidence was lost.

Poppi’s father, who is now in hiding, has never been charged with any offence and denies any wrongdoing. The cause of her death remains “unascertained”.

Last week Worthington refused to answer questions 252 times at the inquest, using his legal right not to potentially incriminate himself.

Armour told the court on Monday that she was aware that Poppi had leg injuries before her death from earlier X-rays.

Alison Hewitt, counsel to the inquest, asked the witness: “Do you recall whether you expressed any view as to whether this is a case of child abuse?”

Armour said: “My remarks were made to that effect – ‘This is strongly suspicious of child abuse’.”

She said there were no natural causes to account for Poppi’s death and that left her with two possible modes of dying, a reflex cardiac arrest or asphyxia, but she could not be sure and had to conclude the cause of death remained “unascertained”.

The inquest, which started last week, has heard that in the early hours of 12 December 2012, Poppi’s mother was asleep downstairs when she heard a scream that was followed by Worthington coming down to fetch a clean nappy. Shortly after he rushed back downstairs holding his lifeless daughter and shouting to his then partner to call for an ambulance.

This second inquest into Poppi’s death was ordered after the controversial first hearing, held by a different coroner, was shrouded in secrecy and lasted just seven minutes.

Later, in a fact-finding judgment as part of care proceedings involving Poppi’s siblings, family court judge Mr Justice Peter Jackson, now Lord Justice Peter Jackson, said Poppi’s “significant bleeding” could only be explained sensibly as the result of trauma.

The hearing was adjourned until Tuesday morning when the witness will be questioned by Paul Worthington’s lawyers.