Do you have something like a big boy "Chuck'E'Cheeses" there? My kids LOVE it there. You could take him there. Ours is called "It'z". I know it's just games and stuff, but it's a blast for kids, and might make for a fun afternoon together. Of course it's just a temporary gift, an xbox lasts longer, but it's more active and interactive too.

Oh, I know! Get him a puppy!! (I'm just kidding!!!)

I agree with tickets to an event like a football game or something. Football shaped barbecue grill? (Again, kidding.)
If he likes the NFL, you could go to the NFL shop website, they have some really cool stuff, and order something from there. I'm a girl, and I could spend a small fortune there if I had it.

I would stay away from things like clothes. Even if he needs shoes, that's just not special enough for a birthday. If he needs shoes badly, maybe, if you can swing it, get him some on the side?

I was just thinking about the "It'z" thing, they do birthday parties too, my son went to two, they're really fun. Maybe you could throw him a surprises party? And maybe get the parents involved too, so they don't feel left out, or feel bad that they couldn't do that for their son.

I don't know, just throwing things out there.