Conventional methods of measuring water discharge and suspended sediment concentration (e.g., water sampling and moving acoustic Doppler current profiler [ADCP]) present challenges in large tidal rivers due to temporal and spatial constraints. This study introduces a novel approach to monitor water discharge and suspended sediment discharge (SSD) in large tidal rivers. Total water discharge and SSD exhibit notable variability in tidal rivers due to the river–tidal interactions; understanding this variability and its causes is essential for effective tidal river management. From June to November 2023, a field study was conducted at Nanjing (NJ) to continuously monitor water discharge, suspended sediment concentration (SSC), and SSD in the tidal reaches of the Yangtze River using coastal acoustic tomography (CAT). Total water discharge ranged from 8,765 to 43,356 m3/s, with a mean of 27,825 m3/s, while tidal discharge varied between −11,998 and 9,983 m3/s, with a mean of 69 m3/s. SSC ranged from 0.02 to 0.09 kg/m3, and SSD ranged from 110 to 3,823 kg/s. Tidal variations in SSC and SSD were within ±0.04 kg/m3 and −1,252 to 1,410 kg/s, respectively. Over short timescales, tides caused instantaneous fluctuations in velocity, water discharge, and SSD, with tides contributing −40% to instantaneous water discharge and SSD at NJ. Over seasonal timescales, no significant wet/dry variations were observed in water discharge, SSC, or SSD during a few months of 2023. Long‐term CAT application (e.g., decades) is required to reveal trends in tidal river dynamics.