Raylene and Carl Brent Worthington did not question their daughter's failure to develop normally, Dr. Sayonara Mato, who specializes in infectious diseases at a Portland, Ore., hospital told Clackamas County Circuit Court in Oregon City, Ore.

They also ignored a cyst that swelled when she had an infection and chose not seek medical help when the girl's distress became conspicuously noticeable shortly before she died, Mato testified.

Ava died at home March 2, 2008, of pneumonia, a blood infection and complications caused by a cyst that interfered with her windpipe and esophagus.

Her parents, members of an Oregon City church that practices faith healing, are charged with manslaughter and criminal mistreatment for failing to provide medical treatment for their daughter.

The Worthingtons said Ava never saw a doctor and her medical condition was never assessed, The (Portland) Oregonian reported. Consequently, they didn't know what warning signs to watch for and did not question the child's failure to grow, Mato testified.

No one in the Worthington family, including their 5-year-old daughter, has been to a doctor, The Oregonian said.

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