The manuscript reflects the opinion of the authors about the need for a hydromorphological approach for the management of Chilean rivers. A brief state-of-the-art of the recent scientific advances on hydromorphological approach to river management is presented, as well as a general overview of the conditions of Chilean rivers and the mayor disturbances they suffer. Moreover, the need to take into account both direct and indirect services provided by rivers in the decision making process on river management is underlined. Hydromorphology is claimed to be a main element to be considered while assessing the ecological state of rivers. Understanding how the hydrological and morphological variables interact dynamically is indeed key to assess the presence or absence of dynamic equilibrium, a condition that, in turn, promotes both habitat diversity and self-sustainable aquatic and riparian ecosystems. The authors also emphasized the need for a change of paradigm in current Chilean rivers management practices, by developing a unified framework to assess hydromorphological and ecological river conditions. In addition, the implementation of specific legislation aimed at promoting ecological and geomorphological standards in river management practice, and the strengthening and widening of the academic teaching of fluvial ecology and geomorphology is suggested.