In this song Otto visits the emotions a parent prays never to experience in a tribute to St. Jude Children's Hospital in Memphis.
Otto co-wrote this touching ballad with Monty Criswell. He told AOL's The Boot about the story behind the song: "That song was written about a friend of Monty's whose child was diagnosed with cancer. He asked me if it was something that would be too heavy to write about. I related it to my mother-in-law [who had] breast cancer and how it affected me -- I was so afraid when it happened. You put it in reverse and go, 'How hard would it be to see your child go through cancer?' It's horrible. I can't imagine anything worse. So we tried to put ourselves in the position of being a father, what would you be going through. I ended up going to St Jude [Children's Research Hospital] a few years later and got to know some of the kids and doctors and see what they do there. I really found a reason to put the song on my record while I was there. I didn't have any experience with it necessarily until then, so it really took hold there."
The lyrics for "Mary, Did You Know?" were written by Christian singer and comedian Mark Lowry, after his pastor asked him to write a Christmas musical for their church. Southern gospel musician Buddy Greene later added music to his words.