A toddler was taken to hospital three times but on the third visit he had died.

Content warning: Some readers may find this story distressing.

The death of a Melbourne toddler has raised concerns around the current state of hospital reporting for children at risk of abuse.

The unnamed 22-month-old child died from cardiac arrest but his history of three presentations to emergency rooms has caught the attention of detectives.

The Age is investigating the events surrounding the death after leaked documents suggested the child presented with symptoms that may have indicated sexual abuse.

The paper said there were no interventions or formal reports made even though two of his presentations had him with ‘intimate swelling and bruising’.

The hospital’s forensic team were said to have been involved after his second last presentation but there was no report made by the Department of Human Services.

One of the largest red flags drawn by the paper was the involvement of a Melbourne man who was connected to the child on each of his visits.

The paper gave him the name 'Andrew' and said he was 30-years-old with an extensive criminal record that included assault and stalking.

The man was said to be the boyfriend of the child's mother.

The child was allegedly in Andrew's care when he was said to have begun choking before suffering the cardiac arrest that caused his death.

The paper reported that in the months following the death, Andrew was repeatedly reported to police for allegedly breaching a family violence intervention order.

The 30-year-old was not charged or placed in custody. Victoria Police were said to have been contacted to comment on this but declined to do so.

Andrew has once again caught the attention of the paper after it was reported he was involved in the emergency room presentation of a second child.

The second child known as three-year-old Stevie was said to be sleepy and disorientated when he was brought to the Royal Children's Hospital in Melbourne on 29 April this year.

The child was admitted and soon tested positive for methamphetamine.

The mother was said to have told staff the drug may have been brought into her home by Andrew who was described as an "on again, off again" boyfriend.

The incident was brought to the attention of police and is said to remain under investigation.

The issue that underlies all these instances is the lack of intervention by social services or reportage by hospital staff.

The case of the first child is horrific in the opportunities for intervention that were placed before teams of professionals.

The Royal Children's hospital has reporting built into their own guidelines that says a staff member must report concerns if they form a reasonable belief that a child has suffered, or is likely to suffer significant harm from abuse.

The obtained leaked file from the Department of Health is said to have shown three instances where staff could have raised concern's about the child's welfare.

Royal Children's chief executive officer, John Stanway told the paper the staff were deeply affected by the child's death.

"We are mindful that for staff who cared for Sam, to the best of their knowledge and ability, the child's subsequent death has been a source of ongoing distress," he said.

Victoria's Children's Commissioner, Liana Buchanan told the paper there was a need for change in order to ensure children were protected.

"There's an urgent need for better information sharing to prevent violence and abuse. We also need reform to ensure all services understand and respond to the connection between family violence and Child Protection," she said.

The man known as Andrew denied any suggestion of wrongdoing to the paper in a statement given to the paper by his lawyer.