A toddler allegedly stamped to death by her mother and ex-boyfriend was treated for a 'non-accidental' head injury in hospital three months before she died, a court heard today.
Ayeeshia Jane Smith, who had also been in care but was allowed to return home, suffered bleeding on the brain but doctors failed to investigate if it was child abuse, a jury was told.
Her mother Kathryn Smith, 23, denies murdering her daughter with the help of her former boyfriend Matthew Rigby, 22, who allegedly kicked or shook Ayeeshia so hard they tore her heart.
Today their trial heard the toddler, who died in May 2014, was taken to hospital by ambulance on February 3, 2014, with a suspicious head injury but doctors ruled out child abuse.
Doctor Kathryn Ward, a consultant paediatrician, said the child also saw a GP in January 2014 because of her alopecia, probably caused by 'trauma' at home or having her hair torn out.
On trial: Kathryn Smith, 23, and her partner Matthew Rigby, pictured smoking outside court today, deny murdering Smith's daughter Ayeeshia Jane Smith, who had been in care but returned home before she died
Attack: Ayeeshia Smith suffered a cardiac arrest, which prosecutors claim was caused by a stamp to the chest or being shaken, and had previously been in hospital with a 'non-accidental' head injury, it was said
Dr Ward told the jury: 'It's well documented that child abuse may present in a child that has previously been well that suddenly collapses with an apparent life-threatening event.
'Signs of abusive head injury include a recurrence of life-threatening events, vomiting, and a call by the child's carer to the emergency services. These are red flags to doctors.
'There is no evidence this possibility (child abuse) was considered on February 3 (by doctors). It's probable that the event on February 3 was associated with non-accidental head injury.'
Ayeeshia's alopecia, which was reported to doctors on January 7, 2014, could have been the result of 'trauma' caused by hair pulling, the court heard.
Dr Ward said: 'Many stresses can cause children to have areas of hair loss, though it is uncommon in children younger than two.
'Children can pull out their own hair or someone else can pull on their hair. One of the problems in assessing the cause was by the time dermatologists saw Ayeeshia the hair was growing back.
'In my opinion the most likely cause would have been a viral infection or possible traumatic hair loss.'
After returning to her mother's care, Ayeeshia remained subject to a child protection plan and was visited regularly by health professionals.
'She had rather fewer contacts with the GP than is average for her age but she had very frequent contact with health visitors which would be usual for a child subject to a child protection plan.
'Smith was advised not leave Ayeeshia more than four hours between feeds and not to let her sleep longer than two because her weight had tailed off.
'There was a consistent pattern that she (Smith) wasn't keen to engage with the children's centre and other support mechanisms.
'The health visitors had experiences of not getting into the house although there was a requirement for them to do so for the purposes of the child protection plan.'
The 21-month-old was also taken into care for safety reasons but social workers handed her back to her mother seven months before she died, the court heard today.
She was moved to a foster family because of excessive weightloss and domestic abuse fears, but was returned to mother Kathryn Smith, 23, seven months before she died.
After coming home the child's health deteriorated again and she lost a kilo in six weeks but remained with her mother until she died, Birmingham Crown Court heard.
Today their trial heard that Derbyshire County Council placed Ayeeshia into care in June 2103.
Tragic: Ayeeshia Jane Smith was only 21 months old when she was allegedly murdered in May 2014 - sevcen months after returning to her mother's care
Health professionals and social workers visited her regularly throughout 2013 where they raised concerns about her weight and eating habits - she was also 'scared' of men, it was said.
Concerns had been raised by social services over Smith's then boyfriend, Joshua Collier, who had a history of 'domestic violence' and the 'potential impact' it had on Ayeeshia.
Ayeeshia spent six months with a foster family before being returned to Smith on October 8, 2013 - just seven months before her death on May 1, 2014.
Expert witness doctor Kathryn Ward wrote a report on Ayeeshia's death based on all available medical, police and social services reports.
She said: 'There were concerns about her engagement with health professionals.
'There were concerns about domestic violence and the potential impact that could have on a young child.'
Dr Ward also told the court that when Ayeeshia was taken into foster care she was 'wary' of men and reluctant to eat solid foods.
She added: 'She would only take milk from a bottle and had been reluctant to take solids.
'She would wake every couple of hours in the night which was unusual seeing as she was nearly a year old at the time.
'She would take a couple of gulps of milk in the night then go back to sleep.
'She was wary of men though she had come to trust the foster carer's husband.
'With encouragement she was now taking solids well and her weight went up from 6.8 kilograms (when she was in Smith's care) to 7.6 kilograms which was a healthy weight.
'She had an acceleration in growth velocity and was a more well-nourished looking child.'
During her time in care she spent time unsupervised with Smith.
In September 2013 health care professionals raised concerns that Ayeeshia's improved health since being taken into care was declining.
Dr Ward said: 'There were concerns that routines weren't being kept and Ayeeshia wasn't being fed in the time frames she was spending with her mother.
'She was reverting to drinking milk during the day then having two meals in the evening when returning to the foster career.'
The court heard that in May, 2013, Smith appeared before a court where she signed a supervision order to ensure Ayeeshia's welfare.
She agreed to move with Ayeeshia to live with her mother in Buckinghamshire.
But the following month she broke the conditions of the agreement by returning to Swadlincote, Derbyshire and the little girl was taken into care.
On January 7, 2014, Ayeeshia was taken to Queen's Hospital in Burton-on-Trent, Staffs., following a 'life-threatening event'
Dr Kathryn Ward told the jury: 'There was no evidence of a fever or that the child had a preceding illness
'Her temperature was 35.3C, which is a degree or so lower than is normal. So the child was certainly compromised.
'But febrile convulsion is usually accompanied by fever. There was no evidence of that.'
When Smith was visited by health professionals on March 29, 2014, she weighed 9.1kg, which had fallen from 10.01kg in just six weeks.
During an unscheduled visit by a social worker on April 14, 2014, it was noted she was 'bright and happy and sociable'.
However, the social worker also reported she was 'quite small and very slim'.
Later that month she was taken to hospital with a bruise on the top of her noise following what her parents said was a fall from her potty.
While being examined by doctors she 'was flitting from one thing to another and wouldn't sit still'.
The trial the court heard Ayeeshia had only eaten a packet of crisps, a chocolate biscuit and a yoghurt on the day she was murdered.
Earlier in the trial the couple's neighbour Tracey Roberts told the jury she frequently heard the coupling arguing.
She also said she heard Ayeeshia scream 'stop mummy, stop daddy' days before her death.
The court also heard Smith has split up from Ayeeshia's father, Ricky Booth, 21, several months earlier.
The trial, which is expected to last until next month, continues.
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