Screen-based digital media devices potentially impact pediatric sleep health, which is fundamental to healthy development. Systematic reviews of the literature consistently show that screen use is associated with delayed bedtimes, shorter sleep duration, and reduced sleep quality. Studies also demonstrate that interactivity, content, and timing of exposure influence sleep health and that the effects of interventions are small and difficult to achieve. The mechanisms underlying these associations include (1) activity displacement, (2) decreased interoceptive awareness, (3) psychological/emotional stimulation from the content or social interaction, (4) physiological effects of light exposure, and (5) noises, beeps, and vibrations from devices during the sleep period. Due to limitations in both data quality and study design, future research should seek to improve measurement of timing and content of digital media. Efforts should be invested in developing, implementing, and evaluating sustainable interventions to reduce the negative effects of screen use on sleep health. These studies should also consider potential moderating factors (e.g., age, sex, race/ethnicity) and other downstream consequences on child health and development. We conclude with recommendations to help mitigate the possible effects of screen use on sleep, including making sleep a priority, facilitating screen-free bedtime routines, and removal of devices from bedrooms.