The barriers to initiating and holding conversations about sexual and relationship health with young people are under researched within the acute paediatric care setting, with the majority of research focussing on these discussions within primary care settings. This qualitative research study aimed to explore how healthcare professionals discussed sexual and relationship health with young people within an acute care context. Six semi-structured focus groups were held with healthcare professionals (n = 24) from within an acute children’s hospital. This inquiry highlighted different approaches of professionals to initiating and engaging in conversations with young people, which included avoidance, reluctance and confidence. The professionals’ ability to open dialogues with young people was influenced by their levels of knowledge and information, their personal beliefs and the availability of private time and space. Those conversations that did take place focussed on physiology, fertility or medication and did not frequently explore issues of relationships and sexuality. Further training and education is needed to equip staff to initiate and engage in discussions about sexual health.