An out-of-hours GP admitted meningitis was not on her "diagnostic radar" when examining a nine-month-old girl.
Dr Elizabeth Anderson referred Kate Pierce to Wrexham Maelor Hospital in March 2006 with concerns she had a chest infection, an inquest has heard.
Kate was diagnosed with tonsillitis and sent home, but was later found to have meningitis which cased severe brain damage. She died in Florida in 2013.
Dr Anderson said she had "homed in more on her chest symptoms".
Asked why meningitis was not on her radar, she said: "Perhaps it should have been."
The inquest in Abergele heard Kate's parents Diane and Mark Pierce had sought medical help after she began vomiting green mucus.
The jury heard they asked for a second opinion after tonsillitis had been diagnosed.
The hospital doctor said he would check but returned 45 minutes later claiming his superior had said the family was free to go.
When Kate's condition deteriorated days later she was diagnosed with pneumococcal meningitis and rushed to Alder Hey children's hospital in Liverpool, but she had already suffered brain damage.
It left her requiring 24-hour care before she died in her sleep during a holiday to Florida in March 2013, aged seven.
Mr Pierce told the hearing that the doctor who diagnosed tonsillitis had examined his daughter while she was asleep, had not removed any of her clothing and mentioned no possible cause of her illness.
The diagnosis "didn't seem to explain how a child with tonsillitis can be like that," he said.
Jurors have been told the inquest will look into how Kate was treated at Wrexham Maelor hospital in March 2006, rather than the circumstance of her death.
The hearing continues.