Suspended sediment plays a vital role in the regional and global cycling of carbon and nutrients by carrying carbon and nutrients from headwaters into lowland rivers and the oceans. Sediment transport through river systems is often fundamentally modified by human activities such as reservoir management. However, a physically-based representation of sediment transport is still missing in most existing Earth system models (ESMs), which are essential tools for modeling and predicting Earth system changes. Here, we introduce a multi-process river sediment module for ESMs, which includes (1) hillslope soil erosion and sediment discharge into streams, (2) sediment transport processes through river networks, (3) reservoir operation based on the inflows from upstream areas and water demand from downstream areas, and (4) sediment trapping by reservoirs. All model parameters are estimated a priori without calibration. We apply this new sediment modeling framework to the contiguous United States and validate it against historical observations of monthly streamflow and sediment discharges at 35 river gauges. The model reasonably well captures the long-term balance and seasonal variations of suspended sediment in large river systems. Furthermore, our model results show that suspended sediment discharge in managed rivers is affected more by reservoirs' direct trapping of sediment particles than by their flow regulation. This new sediment module enables future modeling of the transportation and transformation of carbon and nutrients carried by the fine sediment along the river–ocean continuum to close the global carbon and nutrient cycles.