Some call them million-dollar babies.
Others refer to it as a multibillion-dollar problem.
Any way you slice it, when a child in Canada is born with fetal alcohol spectrum disorder, the bills pile up.
Extra visits to the doctor. Psychiatric care. Special education fees. Foster care. Prisons and policing. Damaged property. Lost wages.
According to one study, Canadian taxpayers and families shoulder a $5.3-billion burden each year just for the health care, education and social service needs of people living with FASD.
"It's staggering," said Brenda Stade, a nurse and FASD researcher at St. Michael's Hospital in Toronto.
FASD is the leading cause of developmental and cognitive disabilities in Canada. It is entirely preventable and if children are assessed and diagnosed early in life, it is also potentially treatable. With the right help, most kids born with alcohol-related birth defects can learn, hold jobs and, depending on their level of disability, live independently.
Stade was the lead researcher on a study looking at the economic burden of FASD for children from one day old to 53 years old. Using the only known incidence rate for FASD in Canada -- one in 100 live births -- Stade extrapolated that there are 242,906 people age 53 and under living with FASD in Canada today.
It is likely a conservative estimate since most FASD experts believe a significant number of children is never diagnosed.
Stade surveyed 250 parents and caregivers as well as some FASD patients themselves about doctor visits, therapy needs, education extras, foster care costs, even things such as lost wages for caregivers and parking fees paid to take kids to see the doctor.
All told, Stade found the average annual cost for a person with FASD exceeded $21,600 a year.
Younger kids and those with severe disabilities can rack up annual tallies of more than $30,000.
By the time a child with FASD turns 18, the special costs associated with their disabilities will reach nearly $400,000 on average. They'll hit the million-dollar mark by the time they turn 46.
Taxpayers foot the bill for about 75 per cent of that. Stade said while she is more concerned with the cost to quality of life of a child with FASD, figuring out the dollars and cents gets the attention of both policy-makers and the public.
"We had to look at a cost-benefit analysis," said Stade.
The cost drivers of FASD evolve from the disabilities the condition imposes on its victims.
Studies have shown that more than 90 per cent of kids with FASD will have mental-health disorders including attention and mood disorders. They see doctors more often, are prescribed more medication and have more needs for therapies such as speech and occupational therapy than other kids.
People with FASD are also more likely to end up in foster care, have trouble in school, develop substance abuse problems of their own and get into trouble with the law. Each issue brings its own additional bills.
Stade notes her study did not include the justice system costs because at the moment, researchers have not been able to adequately assess it.
It likely would bump up the $5-billion figure significantly.
As many as 25 per cent of young offenders are believed to have symptoms or a diagnosis of FASD. A well-respected American study found 60 per cent of kids with FASD had been in trouble with the law. A study in Manitoba found at least 10 per cent of offenders in Stony Mountain Penitentiary had FASD.
Manitoba Liberal Leader Jon Gerrard estimates offenders with FASD likely account for 25 to 50 per cent of what Manitoba Justice spends on its justice system.
His report also suggests between 20 and 33 per cent of the costs of the child welfare system, and up to 10 per cent of the cost of both the education and health care systems can be attributed to people with FASD.
All totalled, Gerrard estimates a hit to the provincial budget of somewhere between $426 million and $924 million in a single year -- or between five and 11 per cent of the budget.
In other words, somewhere between $5 and $10 of every $100 the province spends can be traced back to FASD.
"When I did the arithmetic, I was blown away," said Gerrard. "I hesitated to even write (the numbers) down because they were so huge."
But Gerrard said the estimates show Manitoba has a major problem and the responses to date are just not adequate.
In 2007-08, provincial and territorial governments together budgeted more than $26 million on FASD prevention and treatment programs. Four provinces and two territories didn't budget a cent.
Manitoba, at $7.5 million, was second only to British Columbia which spends $10 million.
Manitoba Healthy Living Minister Jim Rondeau said the province's spending on FASD now tops $11 million annually.
"The program is expanding drastically," said Rondeau.
He said the government knows FASD is a long-term issue that affects everything, but the problem can't be fixed overnight.
"There isn't a simple solution to a complex issue," he said.
The biggest issue raised by almost anyone working with people with FASD is whether they are diagnosed early enough and that programs that help are made available to them.
"There are interventions that can help," said Stade. "I'm just not sure how we're spending money to really help."
-- with files from Mary Agnes Welch