A four-year-old boy who was crushed to death after a 19-stone mirror fell on him in a designer shop died in "an accident that was waiting to happen," a coroner has stated.
Senior Oxfordshire Coroner Darren Salter's comments came after an inquest jury returned a narrative verdict in to the death of Austen Harrison.
The youngster had been playing with a heavy steel-framed fitting-room mirror while his father tried on a suit at a Hugo Boss shop when it toppled on to him, causing "devastating" head injuries, Oxford Coroner's Court heard.
The jury found: "The mirror came to fall on Austen after he moved the wings, causing the unfixed mirror to become unstable.
"The jury believes that the mirror should have been fixed to the wall and that the wall should have been reinforced. We do not believe the mirror was fixed to the wall."
Austen of Crawley, West Sussex, was with his parents Simon and Irina Harrison when he was injured at the Bicester outlet village in Oxfordshire on June 4 2013 at around 8.30pm.
He underwent an emergency operation to relieve pressure on his brain but died four days later in hospital after life-support was switched off.
The jurors, who had been listening to evidence at the Oxford hearing for three days, said safety checks should have been carried out.
They stated: "We believe there were health and safety systems in place but are not confident that these systems would have avoided any danger posed by the mirror. In any case, these sytems do not seem to have been followed."
The coroner said he is writing a report about the case to the Chief Coroner in the hope of preventing future incidents.
Mr Salter said: "It is surprising to me that the mirror stayed in its position for possibly up to six months with staff and customers moving its wings. Sadly, this was an accident waiting to happen and sadly it happened to young Austen.
"You would not expect such a heavy mirror to be free-standing and unsupported in any way."
The inquest heard that the 6ft 6in (2m) high mirror, which weighed 19 stone (120kg), was not fixed to the wall and that its free-standing position on the floor meant it could easily overbalance.
Austen had been playing with the mirror's large wing panels, which were attached by hinges, and as Mr Harrison turned away he heard a huge bang.
Doctors at the John Radcliffe Hospital told the family that Austen would not recover from the "irreversible" damage.
Life support was switched off and he died on June 8 at 5.45am.
Evidence from health and safety experts suggested the mirror would have been "very unstable" as it stood on the floor, that there was "no form of free-standing support", and that opening the wings of the mirror would change the centre of gravity, causing it to fall forwards.
The coroner said health and safety systems had been "in place but were not followed" and that this lack of understanding and responsibility was something that "seems to be accepted" by Hugo Boss.
He also noted that the company had made efforts to improve, including hiring a health and safety manager and training for staff.
After the verdict, Mr Harrison spoke briefly with his lawyer before leaving by a back door, without further comment about the death of his only child.
In a statement Hugo Boss later said: "The global Hugo Boss team has expressed its heartfelt condolences to the family, and our thoughts are of course still with them.
"Our team remains extremely saddened by the incident. Given the ongoing investigations, it would be inappropriate to comment further."