I spent a week covering on the children's unit for the first time in my career. The flow of work is different, but I don't imagine folks are much interested in that. You want to know about the kiddos.
Most of it isn't horrifying, just sad.
Only about half of them were seriously ill, which surprised me. The rest were mostly just sad cases, of things not working right. They had parents who expected them to smarten up and do their chores and not give any lip. The phrase "doing this for attention" came out of those parents' mouths a lot more than you'd like. These are generally kids who have too much anxiety, or too little central nervous system control, or are depressed, or obsessional, and just can't quite manage to do what the other kids in the family or at school do. They aren't horribly out of control, but it all winds into a deteriorating pattern of a kid who can't meet expectations, and a moderately stupid or unsympathetic or bullheaded parent who thinks They Could Do It If They Just Tried, leading to yelling, rejection, tantrums, and eventually, a parent who wants their child gone somewhere else, overwhelmed in the same way that the progeny are. No serious pathology at any given point, just everyone dragging each other under the water, until the child does something dramatic like tie a cord around his neck or get suspended for fighting.
Those are never intact families, but chaotic, boundaryless ones.
There are also mean kids, that everyone hopes are just ill in some treatable way or will respond to a more structured environment. We are often the last stop before juvenile detention, as the last team of experts shakes their heads and say she's got some anxiety or mood disregulation that we can reduce, but that's not the main problem. The main problem is that she doesn't care anything for others. They are just objects to her. Sometimes those parents are just fine, so that you wonder if it's some genetic quirk or undiscovered prenatal or early childhood disease that just leads to dead conscience in some biological way.
The kids with the more serious illnesses are in a different world, even there. The sad, mostly healthy kids interact with them less. They often come from "placements" and are going through an especially bad patch, with everyone hoping that some medication change will do at least minor magic. Sometimes it does, but mostly it's just tweaking and trading off side effects. Those parents are often bewildered or at their wits' end, but they seem like you and me. Or more precisely, the percentage of pathological parents seems about the same as in the general population. The others are much like those I used to see at Little League or youth group.
Underneath it all is the chronic shortage of child psychiatrists (and even greater shortage of good ones, of course). Less dramatically but still seriously, a shortage of child psychologists, psych nurses. Maybe social workers - you'd think I'd know that about my own field, but I don't. Not enough well-trained people, so we rely on people we can pay very little and hope they have natural kindness and intuitive ability to deal with strange children. Some can, quite remarkably. But most of the psych techs dread being sent to the kids' unit to cover.