Turbidity is used as a surrogate for suspended sediment concentration (SSC), and as a regulatory tool for indicating land use disturbance and environmental protection. Turbidity relates linearly to suspended material, however, can show non-linear responses to particulate organic matter (POM), concomitant with changes in particle size distribution (PSD). In the paper the influence of ultra-fine particulate matter (UFPM) on specific turbidity and its association with POM in suspended sediment are shown for alpine rivers in the Southern Alps of New Zealand. The approach was two-fold: a field-based investigation of the relations between SSC, POM, and turbidity sampled during event flow; and experimental work on hydrodynamic particle size effects on SSC, POM, PSD, and turbidity. Specific turbidity changes over event flow and are sensitive to increasing proportional amounts of sand, UFPM, and POM in suspension. Furthermore, the UFPM is the size fraction (<6 μm) where POM increases. The implications of the current study are that the slopes of turbidity-SSC relations are undesirable in locations that may be dominated by cyclic release of POM or distinct pulses of fine-grained material. At locations where the turbidity-SSC slopes approximate 2, the POM proportion is usually <10% of the total suspended load. However, when turbidity-SSC slopes are <1 this is likely caused by high amounts of side-scatter from UFPM concomitant with higher proportions of POM. Thus, the use of turbidity as a proxy for determining SSC may have serious consequences for the measurement of representative suspended sediment data, particularly in locations where POM may be a significant contributor to overall suspended load.