Introduction
The purpose of this study was to describe barriers and facilitators to non-screen-time bedtime routines, including no screen-time at bedtime. Prior research indicates an appropriate balance of sleep and screen-time is a critical contributor to children’s physical and mental development. Promoting bedtime routines and eliminating screen-time before bed may help facilitate appropriate amounts of both behaviors. Nonetheless, few preschoolers meet screen-time guidelines (≤1 hour/day), potentially due to nightly screen-time.

Methods:
Parents of preschoolers (ages 3-4 years, 58% White, 51% male) at risk for inadequate sleep (meeting few [0 or 1] of the 24-hour movement guidelines for physical activity, screen-time, or sleep) participated in a cross-sectional qualitative study. Trained interviewers conducted semi-structured interviews (mean: 45 minutes) focused on children’s weekly habits and barriers and facilitators to healthy sleep and screen-time practices. Thematic analysis was performed using an iterative process, and applicable codes were reviewed to create themes.

Results:
Interviews were conducted with 42 parents. Most reported screen-time at night (88%, 37/42), mainly within 30-minutes (42%, 18/42), or 30-minutes to 1-hour before bedtime (22%, 9/42). Accordingly, screen-time was used as part of children’s bedtime routines; for example, preschoolers would watch TV after bath-time and before going to bed. Main barriers to non-screen bedtime routines were identified: 1) TV in the preschooler bedroom, 2) use of screen-time as a wind-down activity during bedtime, and 3) caring for younger siblings and preschoolers joining older sibling’s screen-time routines. Some parents (19%, 8/42) reported using melatonin to address hyperactivity after screen-time in their bedtime routine. The only identified facilitator of non-screen-time bedtime routines was screen limiting practices, such as forbidding nightly screen-time or using a timer to limit evening activities.

Conclusion:
In this sample, screen-time use within the bedtime routine was prevalent, with family and parent practices contributing. Family bedtime routines and modifications to the preschooler bedroom environment (e.g., removing TV from bedroom) could be targeted to reduce screen-time before bed, thus limiting child screen-time and improving sleep patterns.