The river starts in the form of many small streams on the eastern slopes of Mount Ruapehu. The Mangatoetoenui Glacier (once also called the Waikato Glacier) is one of the principal sources. The southernmost tributary is called the Upper Waikato Stream. The Waipakihi River joins the Waikato from the Kaimanawa Mountains to the west. From the point where the river meets the Waihohonu Stream, down to Lake Taupo, it has been formally named the Tongariro River since 1945.