The delivery-room nurses gathered around the warmer to quickly clean and swaddle the 7-pound, 5-ounce newborn with the full head of dark hair and rush him right back to his parents.

But they lingered.

Mark Ranalli, in that hospital room as a father, yes, but also a doctor himself, paid attention. He wandered closer.

Mark looked down into the scrunched-up face of his baby boy. And then he noticed his son's arms. They were still, limp, and seemed just a tad too small.

"I stroked him," Mark says of baby Marco. "I loved on him for a few minutes and then I tried to figure out how to tell Amy, in some unalarming way, that something was wrong."

He didn’t. Not right away anyhow. He laid Marco on his mother’s chest and he watched them together.

"Mark gave me 10 minutes. That was the only 10 minutes I had in Marco’s life with no worries," Amy Ranalli recalls. "He gave me a few moments before our life, and everything in it, went sideways."

Mystery condition

Amy sits on the kitchen floor of the family’s rural Westerville home and pulls Marco down, wedging him fairly unsuccessfully between her legs, trying to keep him still, as she pulls on the shin guards and cleats — all hand-me-downs from his brothers, 11-year-old Nico and 9-year-old Rocco.

Only minutes away from his very first soccer practice, 4-year-old Marco can’t stay focused. "Mommy. I might win! I might do a goal!" he says in one breath as she gives the first shoe a tug.

Amy laughs, wrestles him a little closer, ties the second shoe. "It’s not a real game. It’s just practice."

Undeterred, Marco chatters on. "Mooooooommmmmy. I might WIN!"

When she smiles down at him, her son can't see the worry in her eyes. But he feels it.

His smile disappears. "Will I fall Mommy? Can I fall? Will I hit my head?" He looks up to her for assurance.

"Marco. You’ll be fine," she says. But anyone who knows Amy can tell that, for a fraction of a second, she wasn't so sure.

It was a rare but honest moment in the life of a family who works every minute of every day to collectively build the confidence of a little boy who is constantly joyful, disarmingly charming, and navigating a world that simply wasn't made for him.

For Marco, hitting his head is a real risk because he has no way to break his fall.

This is life in the Ranalli household, life where the youngest child can't use his arms — not in the traditional way anyhow. They are there, sure, but of little use.

Something unexplained happened in utero during an outwardly normal and healthy pregnancy — "an event," doctors called it — that prevented Marco’s motor neurons to his arms from firing. And with no stimulus, muscles never formed.

There is no syndrome name, no diagnosis despite the best researchers at Nationwide Children's Hospital, where Mark is a pediatric oncologist/hematologist, looking for one. The good news is that it is not degenerative, and Marco is otherwise healthy. (He is missing four toes on his right foot, which got tangled in strings that had escaped from the amniotic sac). His doctors say he has above-average intelligence.

"Marco is like a happy, bright light in the world," says his pediatrician, Dr. Mary-Lynn Niland. "He always has a smile on his face, full of positivity and persistence."

She says the more the world treats kids like Marco equally, the better off they will be. To help with that, her office was among the first contributors to the fundraising campaign that Amy is leading to build a $135,000 all-inclusive, handicapped-accessible, community playground at Marco’s Hylen Souders Elementary School in Delaware County's Big Walnut School District.

"There is natural segregation that goes on when kids cannot play together," Niland says. "This playground project minimizes differences. Kids like Marco think, ‘I can play here like everyone else.’ They don’t see themselves as so different."

Amy and Mark speak of Marco’s future with nothing but pride and expectations: He’ll live on his own, go to college, maybe be a doctor or lawyer, Mark predicts. But it has taken them awhile to get there. The challenge has tested their faith and, Amy admits, that bothers her maybe more than anything.

"It’s like God gave us a sheet of paper and said, 'Here’s your assignment,'" Amy says. "And we looked at the sheet of paper and it was blank."

But with each passing day, she sees more clearly what her family’s mission might be.

"We are changing attitudes, changing perceptions," Amy says. "We spend all the time filling Marco’s bucket and filling his bucket and filling his bucket with confidence and self-esteem … so that when the world dips into it, it will never empty."