A little boy crushed by a car seat suffered internal bleeding likened to a crash injury, a court has heard.
Alfie Lamb, aged three, died after his mother's boyfriend Stephen Waterson, 25, allegedly squashed him by reversing his car seat.
The boy had been in the rear footwell of Waterson's Audi convertible, at the feet of his mother Adrian Hoare, 23, the Old Bailey has heard.
Adrian Hoare (left with her son), 23, allegedly did nothing to stop Waterson and instead told her son (Alfie is pictured left and right) to be quiet as he screamed out for her to help
Stephen Waterson (pictured) is accused of crushing three-year-old Alfie Lamb to death by reversing his car seat into the youngster in his Audi convertible
A jury at the Old Bailey today saw photographs of the interior of the car where it alleged Alfie suffered his crush injuries
She allegedly ignored his cries of 'Mummy' and told him to 'shut up' on the journey back to their home in Croydon from Sutton in south London on February 1 last year.
Alfie was taken out of the car 'unresponsive' and confirmed dead on February 4 after three days in intensive care.
There were four adults and two youngsters in the car but no child seats in use on the day of the tragedy, jurors have heard.
Paediatric pathologist Dr Andreas Marnerides carried out a joint post mortem examination on Alfie's body at St Thomas's Hospital in London on February 9.
The court heard that Alfie was crushed in the footwell behind the passenger seat when the seat in front was reversed by his mother's boyfriend
The court previously heard how Marcus Lamb was driving, Stephen Waterson was sitting in the front passenger seat, and Adrian Hoare was in the back with Emilie Williams. Ms Williams' daughter was sitting in the footwell in front of her, while Alfie was sitting in the footwell in front of Hoare, and behind Waterson
Alfie's mother, Adrian Hoare, 23, who was in the seat behind her son, is charged with manslaughter alongside Waterson
Waterson denies manslaughter and intimidating Marcus Lamb, also known as Marcus Richardson, on 15 February
He told jurors Alfie had been a 'healthy boy'.
He said: 'In this case we had no positive findings of a natural explanation of a death and we had positive findings it was unnatural, it was trauma related.'
There were a lot of external petechial haemorrhages - tiny red spots caused by ruptured veins - on Alfie's forehead, around the eyes, cheeks, upper chest and behind the ears, the court heard.
There were other similar spots elsewhere, including inside Alfie's chest cavity, Dr Marnerides said.
Alfie Lamb, pictured with his mother Adrian Hoare, suffered massive crush injuries
Alfie died following the incident this Audi convertible which was owned by Waterson in February last year
The pathologist ruled out a possible natural explanation such as sepsis, saying there was 'positive evidence there had been injury that would have resulted in increase in pressure in the body, the abdomen and chest'.
Alfie, pictured, suffered ischemic brain injury caused by deprivation of blood or oxygen and compression asphyxia
Evidence of internal bleeding was explained by impact to the right side of the body, he said.
He told jurors such impact or compression injuries were like those seen in road traffic collisions.
He ruled out Alfie's injuries being caused by efforts to resuscitate him after his collapse.
Fat globules in the lungs also indicated a traumatic injury, he said.
The cause of death was given as ischemic brain injury caused by deprivation of blood or oxygen and compression asphyxia, jurors were told.
Waterson, 25, and Hoare, 23, from Croydon, south London, have denied manslaughter.
The trial continues.
The court heard that Alfie's crushing injures were worse than those in a road traffic accident
The court heard that Alfie's injuries could not have been caused by attempts to resuscitate him