Baby P was probably suffering from eight broken ribs when he saw his GP eight days before his death, the General Medical Council heard today.
An expert said the little boy would have felt "acute pain" from his injuries if he had been picked up at the time of his consultation with Dr Jerome Ikwueke.
It is also likely that the toddler - now named as Peter Connelly - had a mouth injury known as a classic sign of abuse when he saw the doctor on July 26 2007, a GMC fitness to practise panel heard.
Dr Ikwueke, 63, is accused of failing to carry out an adequate examination of Peter or make an urgent referral to hospital despite knowing the child was on the at-risk register and noting his behaviour had changed.
Eight days later, on August 3 2007, he died in a blood-spattered cot in Tottenham, north London, aged 17 months.
Paediatric forensic pathologist Professor Rupert Risdon told the hearing in London today of the extensive injuries found on Peter's body at a post-mortem examination.
The toddler suffered a broken spine between 48 hours and four days before his death - but other wounds were older, the panel heard.
Referring to the broken ribs, Prof Risdon said: "I was of the opinion, having looked at these sections through the microscope, that fracturing had occurred approximately one to two weeks before death."
The expert was asked how much suffering broken ribs would cause a child.
He said: "I would say that rib fractures are painful when they are initially inflicted, but children are surprisingly resilient and often a couple of days later they may be back to playing normally.
"However, if you pick them up or touch the fractured rib, then it will become acutely painful."
Prof Risdon told the hearing that the pain could make a child withdrawn.
Dr Ikwueke observed that Peter had changed from his usual happy self and pulled away from him when he saw him on July 26, the GMC heard yesterday.
Prof Risdon said that "very significant force" would have been needed to break the toddler's ribs.
"The ribs in a child of this age are much more flexible than those of an adult, particularly an older adult, so it is possible to deform the ribs to quite a degree before they will actually fracture," he said.
Peter also suffered a tear to the frenulum, a piece of tissue inside the upper lip, probably caused by a blow to the mouth, the hearing was told.
Prof Risdon said this was inflicted "at least a couple of weeks" before he died, and noted that it was "very characteristic" of non-accidental injury.
Dr Ikwueke, who qualified as a doctor at the University of Ibadan in Nigeria in 1974 and first came to Britain in 1979, denies misconduct.Reuse content