Massimo Piermarini was among the last to reach his grandchildren's home in the small mountain town of Arquata del Tronto after the earthquake hit, early Wednesday morning.
"They didn't want me to go because it was too dangerous, but I said I didn't care, I had to go looking for them," he told Italian media.
"But unfortunately for the little girl there was nothing I could do."
His granddaughter Marisol Piermarini, 18 months old, had died in the night as the house collapsed on her.
The girl's mother, Martina, had moved to the area after surviving the deadly 2009 earthquake in L'Aquila.
This is just one of scores of tragedies emerging from the rubble of picturesque, centuries-old villages nestled in the Apennine mountains.
At least 159 people were killed in the quake, with the toll expected to rise. Dozens more are counted as missing. Hundreds suffered injuries major and minor. Many are now homeless.
As night fell, rescuers became more desperate in their search for the living.
"You keep digging, relentlessly and determinedly in the rubble," said Italian Red Cross president Francesco Rocca. "Every minute counts."
Rescuers spoke of hearing cries for help – and children weeping – in the wreckage. They worked with machinery and with bare hands, terrified of hurting those they were trying to save.
In Pescara del Tronto, dead bodies pulled from the remains of their homes lay in a children's playground.
Sergio Pirozzi, mayor of Amatrice, told RAI: "Half the town no longer exists".
Mr Rocca said volunteers from around the country were flooding into the region including rescuers and psychological support teams, and others setting up field kitchens for survivors left without a home.
The earthquake, 6.2 on the Richter scale and just 4km deep, struck central Italy at 3.36am on Wednesday.
It hit a region 100km north-east of Rome, notorious for serious earthquakes, but populated by towns where most houses were too old to be quake-proofed.
The quake was followed by strong aftershocks: one of magnitude 5.4 at 4.33am in Norcia, in the province of Perugia, and a third violent tremor in the early afternoon sparking panic.
The ancient, stone villages of the mountainous region crumbled, burying their sleeping occupants.
Rescuers with sniffer dogs searched the rubble for survivors into the night.
Some families died together. In Arquata a husband and wife were pulled dead from the rubble along with their two children aged 8, and 7 months.
But there were stories of survival, too.
In Amatrice, a woman told the media "The whole wall fell but it did not hit me… Then the whole ceiling fell on my head – I just managed to put a pillow on my head."
In tiny Pescara del Tronto, a village almost completely destroyed by the quake, a grandmother was pulled alive from the wreckage of her home after throwing herself over her two grandchildren to protect them from the collapsing ceiling, Italy's ANSA reported.
Nearby, on a road where almost every house had crumbled, a man marvelled at his narrow escape. He had just woken up and headed out to work when his home disappeared behind him.
"In an instant everything collapsed," he told ANSA. "Ten seconds were enough to destroy everything."
The quake rocked Italy from coast to coast.
Chandeliers swung and beds jolted in Rome, and roof beams creaked as far away as Venice.
More than 35km from the epicentre, one Italian reported their whole house was shaking, "chandeliers, beds moving violently".
A resident of L'Aquila, where a similar strength earthquake hit seven years ago, said there was a "sound like breaking rocks", her furniture and doors moved about, and objects jumped from shelves.
Another L'Aquila resident said they were in the same house, and same room, as they had been for the previous quake – the walls creaked but this time they had taken the precaution of bolting furniture to the walls.
More than 50km from the epicentre, another witness reported water spouting from plugholes and roof beams splitting.
Con la gente colpita dal #terremoto e con i meravigliosi soccorritori. Dolore e solidarietà #Italia pic.twitter.com/6tGOaTh0sB— Matteo Renzi (@matteorenzi) August 24, 2016
Australia's embassy in Rome was making urgent enquiries with local authorities to try to establish if any Australians were affected.
The head of Italy's Civil Protection Department said "we are in the midst of the relief phase, in which the priority is to save lives, then assistance to the population and subsequently damage relief".
The earthquake-hit region is just to the north of L'Aquila, where a 6.3-strength earthquake killed more than 300 people in 2009.
After that disaster civic authorities were criticised for poor building design in an earthquake-prone region. In 2012 six scientists and a government official were convicted of manslaughter for giving "falsely reassuring" statements about the likelihood of a quake just days before it hit.
Pope Francis replaced his weekly catechesis in St. Peter's Square with a heartfelt address on the earthquake.
"Hearing the mayor of Amatrice say that our town is gone, and knowing that there are children among the dead, I am deeply saddened," the Pope said.
Italian prime minister Matteo Renzi promised Italy would "pull together and show its most beautiful face".