Cheshire coroner Nicholas Rheinberg recorded a verdict of unlawful killing after hearing evidence at the inquest into the death of 19-month-old Shauna Pritchard from Chester, who was found to have a "horrifying list of injuries".

He told the Chester inquest it was believed Shauna, of Western Avenue, Blacon, was the victim of shaken baby syndrome.

Shauna was the daughter of childhood sweethearts Toni Wright and Clinton Pritchard and was born in Chester in 2002.

The couple separated in January, 2003, and Mr Pritchard remained in contact with his children and Miss Wright began a relationship with Damien John Price in December, 2003.

Mr Price was a soldier based at Dale Barracks, Chester and the inquest was told the couple now lived in Worcester.

Miss Wright refused to answer several questions from Mr Rheinberg on the grounds that the answers might incriminate her.

Both Miss Wright and Mr Price were asked if they hurt Shauna.

Mr Price denied any involvement and Miss Wright said: "I didn't harm Shauna. That's all."

Miss Wright also said Mr Price did not harm her daughter.

The inquest heard Shauna was first treated at hospital in February, 2004 after being admitted for conjunctivitis and cellulitis.

A doctor examined the baby and treated the eye problem.

There was then a discussion about bruising on the child's body and the doctor, Dr Chapel, was worried about possible bruising on her neck.

Mr Rheinberg said: "The child's mother stated the bruising had appeared spontaneously over the previous 24 hours and although Dr Chapel doubted whether the bruising had occurred so soon, she feared the possibility of a more serious underlying condition and arranged for Shauna's admission to the Countess as an emergency".

Shauna was also examined by another doctor who was similarly disturbed about the bruising.

He could not see bruising on the neck but said there was bruising on the abdomen.

"He said it was a very unusual place for bruising if it was to be explained by an accident or knocks and bumps encountered by infants and the possibility arose that, at least, Shauna had been roughly manhandled with the marks conductive of an inappropriate grip.

"He couldn't positively say the bruising was evidence of abuse, but he was strangely suspicious it was."

Hospital staff reported their concerns to social services and the police.

"The difficulty that was faced was that all parties involved were denying any deliberate injury of Shauna," said Mr Rheinberg.

"The doctor couldn't positively say Shauna had been injured non-accidentally and, short of arresting a number of people without evidence, it was felt the police inquiries could not take the matter any further. The matter was left to be dealt with by social services."

Mr Rheinberg was told the incident was not properly followed up as a result of staffing problems within the police and social services.

He said: "It's easy to be unfairly critical of both police and social services and look at the totality of the evidence that has come out of this inquiry and condemn early action that might have prevented a tragedy.

"However, when one looks at the evidence there was no more than an uneasiness by a senior paediatrician and no full proof.

"An item that may have swung the favour in balance of full child protection measures would have been a skeletal x-ray that was reported as being clear. A subsequent review of the x-ray by one of the country's leading experts revealed very subtle fractures, pressure fractures of the spine."

Mr Rheinberg offered no criticism of the doctor who initially reviewed the x-ray.

He added: "Two months later Shauna died and the post-mortem examination revealed a horrifying list of injuries."

Shauna was rushed to hospital on April 22 after Mr Price found she was not breathing. Miss Wright had been out at the chemist and Shauna was later transferred to Alder Hey Hospital, Liverpool, where she died.

The post mortem examination revealed three fractures to Shauna's spine, brain haemorrhages and retinal detachment.

"Shauna had been violently thrust down on her bottom with such force that the whole of her spine flexed or hyper-flexed causing this injury, an injury that one might see if a child had fallen from a first or second floor window, and even then one might not see an injury of this sort.

"Professor Carty stated in her opinion, beyond reasonable doubt, a haemorrhage, that she described from observing the scans, was indicative of Shauna being violently shaken."

Mr Rheinberg said all three signs of shaken baby syndrome were discovered in the post-mortem examination.

"These three items of injury together are extremely suggestive of shaken baby syndrome, but not absolute proof," he said.

Mr Rheinberg gave the cause of death as traumatic head injuries and said Shauna was unlawfully killed.

Speaking after the inquest, investigating officer DC Mark Tasker said: "An extensive investigation has already been undertaken into the circumstances of Shauna's death during which police have worked closely with our colleagues in the Crown Prosecution Service.

"We have presently explored all available investigative operations. However, any new information which comes to light will be thoroughly explored.

"This is the time for anyone with any relevant information, no matter how trivial it may appear, to come forward and speak to police.

"We must not forget that a 19-month-old toddler has lost her life. This file will remain open until the person or persons responsible for Shauna's death are brought to justice."