A Kiwi baby who died Australia was sent home from two hospitals and a doctors' surgery because they thought he was just "teething", a Coroner has concluded.
Seven-month-old Malakai Matui Parone, whose dad is from New Zealand, died from meningococcal in Perth's Princess Margaret Hospital (PMH) in 2016.
At an inquest into his death on Tuesday, Dr William Holdaway, of PMH, said the boy could have "fallen through the cracks" due to inconsistent treatment received at a number of hospitals, 7 News reports.
Malakai was taken to Midland Hospital a week before he died, with his mother Nicole Thompson, saying he couldn't move the right side of his body, had joint pain, fever and a rash.
He was given pain relief and sent home.
The next day, Thompson called an ambulance and Malakai was taken to PMH, because his condition had deteriorated.
Thompson was told Malakai was just teething.
It was only on his third visit to PMH that hospital staff realised he needed intensive care - but by then it was too late. Malakai died two days later.
At the inquest on Tuesday, Dr Holloway suggested that in future, doctors should "ensure children's illnesses were followed up at the same hospital or practitioner each time to ensure consistency of treatment", 7 News reports.
Thompson requested the inquest be held, so the quality of care Malakai received could be examined, reports AAP.
The inquest will continue before deputy state coroner Barry King.
Newshub.