Human alterations along stream channels and within catchments have affected fluvial geomorphic processes worldwide. Typically these alterations reduce the ecosystem services that functioning floodplains provide; in this paper we are concerned with the sediment and associated material trapping service. Similarly, these alterations may negatively impact the natural ecology of floodplains through reductions in suitable habitats, biodiversity, and nutrient cycling. Dams, stream channelization, and levee/canal construction are common human alterations along Coastal Plain fluvial systems. We use three case studies to illustrate these alterations and their impacts on floodplain geomorphic and ecological processes. They include: 1) dams along the lower Roanoke River, North Carolina, 2) stream channelization in west Tennessee, and 3) multiple impacts including canal and artificial levee construction in the central Atchafalaya Basin, Louisiana. Human alterations typically shift affected streams away from natural dynamic equilibrium where net sediment deposition is, approximately, in balance with net erosion. Identification and understanding of critical fluvial parameters (e.g., stream gradient, grain-size, and hydrography) and spatial and temporal sediment deposition/erosion process trajectories should facilitate management efforts to retain and/or regain important ecosystem services.