Sub-acute ruminal acidosis (SARA) has become an increasing problem in well-managed, high yielding dairy herds and the monitoring of groups of cows for signs of the condition is now crucial. Rumenocentesis may be ethically questionable but the technique remains the most reliable means of diagnosing SARA. Continuous measurement of ruminal pH may however be possible in the future. Parameters reflecting the metabolic acidosis caused by SARA are also promising tools, and measurement of milk fat content may be useful in individual mid-lactation cows although it is less valuable for bulk tank milk samples. The prevention of SARA includes the establishment of feeding and management guidelines seeking to minimize rumen acidotic load. Regular monitoring may facilitate early recognition of the condition and limit economic losses. Some degree of SARA may however be inevitable and presents a challenge to the dairy industry as consumers become increasingly concerned about the welfare of production animals.