A number of severe flooding events have occurred both in South Africa and internationally in recent years. Furthermore, changes in both the intensity and frequency of extreme rainfall events have been documented, both locally and internationally, associated with climate change. The recent loss of life, destruction of infrastructure, and associated economic losses caused by flooding, compounded by the probability of increased rainfall variability in the future, highlight that design flood estimation (DFE) techniques within South Africa are outdated and in need of revision. A National Flood Studies Programme (NFSP) has recently been initiated to overhaul DFE procedures in South Africa. One of the recommendations in the NFSP is the further development of a continuous simulation modelling (CSM) system for DFE in South Africa. The focus of this paper is a review of CSM techniques for DFE, to guide further development for application in South Africa. An introduction to DFE, and particularly the CSM approach, is presented, followed by a brief overview of DFE techniques used in South Africa, leading into a more detailed summary of CSM for DFE within South Africa to date. This is followed by a review of the development and application of CSM methods for DFE internationally, with a focus on the United Kingdom and Australia, where methods have been developed with the intention of national scale implementation. It is important to highlight that there is a plethora of CSM methods available internationally and this review is not exhaustive; it focuses on and identifies some of the strengths and weaknesses of several popular methods, particularly those intended for national scale application, as the intended outcome from this review is to identify a path towards the development of a usable national scale CSM system for DFE in South Africa. Emphasis on a usable method is important, considering the reality that, despite promising results, numerous benefits, and national scale methods being developed, it appears that the CSM method for DFE is rarely used in practice.