diff --git a/conformance/results/mypy/namedtuples_define_class.toml b/conformance/results/mypy/namedtuples_define_class.toml
index adf590b4..575c5c0c 100644
--- a/conformance/results/mypy/namedtuples_define_class.toml
+++ b/conformance/results/mypy/namedtuples_define_class.toml
@@ -11,11 +11,19 @@ namedtuples_define_class.py:46: error: Argument 2 to "Point" has incompatible ty
 namedtuples_define_class.py:47: error: Argument "units" to "Point" has incompatible type "int"; expected "str"  [arg-type]
 namedtuples_define_class.py:48: error: Too many arguments for "Point"  [call-arg]
 namedtuples_define_class.py:49: error: Unexpected keyword argument "other" for "Point"  [call-arg]
-namedtuples_define_class.py:59: error: Non-default NamedTuple fields cannot follow default fields  [misc]
-namedtuples_define_class.py:98: error: Argument 2 to "Property" has incompatible type "float"; expected "str"  [arg-type]
-namedtuples_define_class.py:105: error: NamedTuple should be a single base  [misc]
+namedtuples_define_class.py:59: error: Invalid statement in NamedTuple definition; expected "field_name: field_type [= default]"  [misc]
+namedtuples_define_class.py:65: error: Missing positional argument "units" in call to "Point2"  [call-arg]
+namedtuples_define_class.py:67: error: Too many values to unpack (2 expected, 3 provided)  [misc]
+namedtuples_define_class.py:76: error: NamedTuple field name cannot start with an underscore: _y  [misc]
+namedtuples_define_class.py:86: error: Non-default NamedTuple fields cannot follow default fields  [misc]
+namedtuples_define_class.py:125: error: Argument 2 to "Property" has incompatible type "float"; expected "str"  [arg-type]
+namedtuples_define_class.py:132: error: NamedTuple should be a single base  [misc]
 """
 conformance_automated = "Fail"
 errors_diff = """
-Line 79: Expected 1 errors
+Line 69: Expected 1 errors
+Line 106: Expected 1 errors
+Line 59: Unexpected errors ['namedtuples_define_class.py:59: error: Invalid statement in NamedTuple definition; expected "field_name: field_type [= default]"  [misc]']
+Line 65: Unexpected errors ['namedtuples_define_class.py:65: error: Missing positional argument "units" in call to "Point2"  [call-arg]']
+Line 67: Unexpected errors ['namedtuples_define_class.py:67: error: Too many values to unpack (2 expected, 3 provided)  [misc]']
 """
diff --git a/conformance/results/mypy/namedtuples_define_functional.toml b/conformance/results/mypy/namedtuples_define_functional.toml
index 151e6588..6356dc8c 100644
--- a/conformance/results/mypy/namedtuples_define_functional.toml
+++ b/conformance/results/mypy/namedtuples_define_functional.toml
@@ -11,7 +11,8 @@ namedtuples_define_functional.py:43: error: Argument "x" to "Point6" has incompa
 namedtuples_define_functional.py:52: error: "namedtuple()" has duplicate field name "a"  [misc]
 namedtuples_define_functional.py:53: error: "namedtuple()" field name "def" is a keyword  [misc]
 namedtuples_define_functional.py:54: error: "namedtuple()" field name "def" is a keyword  [misc]
-namedtuples_define_functional.py:66: error: Missing positional argument "a" in call to "NT5"  [call-arg]
+namedtuples_define_functional.py:55: error: "namedtuple()" field name "_d" starts with an underscore  [misc]
+namedtuples_define_functional.py:69: error: Missing positional argument "a" in call to "NT7"  [call-arg]
 """
 conformance_automated = "Pass"
 errors_diff = """
diff --git a/conformance/results/pyrefly/namedtuples_define_class.toml b/conformance/results/pyrefly/namedtuples_define_class.toml
index fd191957..0d85f64e 100644
--- a/conformance/results/pyrefly/namedtuples_define_class.toml
+++ b/conformance/results/pyrefly/namedtuples_define_class.toml
@@ -1,6 +1,10 @@
-conformant = "Pass"
-conformance_automated = "Pass"
+conformant = "Partial"
+notes = """
+Doesn't catch illegal field name starting with underscore
+"""
+conformance_automated = "Fail"
 errors_diff = """
+Line 76: Expected 1 errors
 """
 output = """
 ERROR namedtuples_define_class.py:32:7-12: Index 3 out of range for tuple with 3 elements [index-error]
@@ -11,8 +15,9 @@ ERROR namedtuples_define_class.py:46:15-17: Argument `Literal['']` is not assign
 ERROR namedtuples_define_class.py:47:24-25: Argument `Literal[3]` is not assignable to parameter `units` with type `str` in function `Point.__new__` [bad-argument-type]
 ERROR namedtuples_define_class.py:48:22-24: Expected 3 positional arguments, got 4 in function `Point.__new__` [bad-argument-count]
 ERROR namedtuples_define_class.py:49:23-28: Unexpected keyword argument `other` in function `Point.__new__` [unexpected-keyword]
-ERROR namedtuples_define_class.py:59:5-13: NamedTuple field 'latitude' without a default may not follow NamedTuple field with a default [bad-class-definition]
-ERROR namedtuples_define_class.py:79:5-6: Cannot override named tuple element `x` [bad-override]
-ERROR namedtuples_define_class.py:98:19-22: Argument `float` is not assignable to parameter `value` with type `str` in function `Property.__new__` [bad-argument-type]
-ERROR namedtuples_define_class.py:105:7-11: Named tuples do not support multiple inheritance [invalid-inheritance]
+ERROR namedtuples_define_class.py:69:20-22: Expected 2 positional arguments, got 3 in function `Point2.__new__` [bad-argument-count]
+ERROR namedtuples_define_class.py:86:5-13: NamedTuple field 'latitude' without a default may not follow NamedTuple field with a default [bad-class-definition]
+ERROR namedtuples_define_class.py:106:5-6: Cannot override named tuple element `x` [bad-override]
+ERROR namedtuples_define_class.py:125:19-22: Argument `float` is not assignable to parameter `value` with type `str` in function `Property.__new__` [bad-argument-type]
+ERROR namedtuples_define_class.py:132:7-11: Named tuples do not support multiple inheritance [invalid-inheritance]
 """
diff --git a/conformance/results/pyrefly/namedtuples_define_functional.toml b/conformance/results/pyrefly/namedtuples_define_functional.toml
index 35a38690..40c47f73 100644
--- a/conformance/results/pyrefly/namedtuples_define_functional.toml
+++ b/conformance/results/pyrefly/namedtuples_define_functional.toml
@@ -16,5 +16,6 @@ ERROR namedtuples_define_functional.py:43:17-20: Argument `float` is not assigna
 ERROR namedtuples_define_functional.py:52:31-34: Duplicate field `a` [bad-class-definition]
 ERROR namedtuples_define_functional.py:53:33-38: `def` is not a valid identifier [bad-class-definition]
 ERROR namedtuples_define_functional.py:54:33-38: `def` is not a valid identifier [bad-class-definition]
-ERROR namedtuples_define_functional.py:66:4-6: Missing argument `a` in function `NT5.__new__` [missing-argument]
+ERROR namedtuples_define_functional.py:55:33-37: NamedTuple field name may not start with an underscore: `_d` [bad-class-definition]
+ERROR namedtuples_define_functional.py:69:4-6: Missing argument `a` in function `NT7.__new__` [missing-argument]
 """
diff --git a/conformance/results/pyright/namedtuples_define_class.toml b/conformance/results/pyright/namedtuples_define_class.toml
index 19f9aadc..e04b26fc 100644
--- a/conformance/results/pyright/namedtuples_define_class.toml
+++ b/conformance/results/pyright/namedtuples_define_class.toml
@@ -10,11 +10,13 @@ namedtuples_define_class.py:47:24 - error: Argument of type "Literal[3]" cannot
   "Literal[3]" is not assignable to "str" (reportArgumentType)
 namedtuples_define_class.py:48:22 - error: Expected 3 positional arguments (reportCallIssue)
 namedtuples_define_class.py:49:23 - error: No parameter named "other" (reportCallIssue)
-namedtuples_define_class.py:59:5 - error: Fields without default values cannot appear after fields with default values (reportGeneralTypeIssues)
-namedtuples_define_class.py:79:5 - error: Cannot override "x" because parent class "Point" is a named tuple (reportIncompatibleVariableOverride)
-namedtuples_define_class.py:98:19 - error: Argument of type "float" cannot be assigned to parameter "value" of type "str" in function "__new__"
+namedtuples_define_class.py:69:20 - error: Expected 2 positional arguments (reportCallIssue)
+namedtuples_define_class.py:76:5 - error: Named tuple field names cannot start with an underscore (reportGeneralTypeIssues)
+namedtuples_define_class.py:86:5 - error: Fields without default values cannot appear after fields with default values (reportGeneralTypeIssues)
+namedtuples_define_class.py:106:5 - error: Cannot override "x" because parent class "Point" is a named tuple (reportIncompatibleVariableOverride)
+namedtuples_define_class.py:125:19 - error: Argument of type "float" cannot be assigned to parameter "value" of type "str" in function "__new__"
   "float" is not assignable to "str" (reportArgumentType)
-namedtuples_define_class.py:105:7 - error: Multiple inheritance with NamedTuple is not supported (reportGeneralTypeIssues)
+namedtuples_define_class.py:132:7 - error: Multiple inheritance with NamedTuple is not supported (reportGeneralTypeIssues)
 """
 conformance_automated = "Pass"
 errors_diff = """
diff --git a/conformance/results/pyright/namedtuples_define_functional.toml b/conformance/results/pyright/namedtuples_define_functional.toml
index 07c43204..266f4083 100644
--- a/conformance/results/pyright/namedtuples_define_functional.toml
+++ b/conformance/results/pyright/namedtuples_define_functional.toml
@@ -1,4 +1,4 @@
-conformant = "Pass"
+conformant = "Partial"
 output = """
 namedtuples_define_functional.py:16:8 - error: Argument missing for parameter "y" (reportCallIssue)
 namedtuples_define_functional.py:21:8 - error: Arguments missing for parameters "x", "y" (reportCallIssue)
@@ -15,8 +15,13 @@ namedtuples_define_functional.py:43:17 - error: Argument of type "float" cannot
 namedtuples_define_functional.py:52:31 - error: Names within a named tuple must be unique (reportGeneralTypeIssues)
 namedtuples_define_functional.py:53:33 - error: Field names cannot be a keyword (reportGeneralTypeIssues)
 namedtuples_define_functional.py:54:33 - error: Field names cannot be a keyword (reportGeneralTypeIssues)
-namedtuples_define_functional.py:66:1 - error: Argument missing for parameter "a" (reportCallIssue)
+namedtuples_define_functional.py:55:33 - error: Named tuple field names cannot start with an underscore (reportGeneralTypeIssues)
+namedtuples_define_functional.py:59:33 - error: Named tuple field names cannot start with an underscore (reportGeneralTypeIssues)
+namedtuples_define_functional.py:60:13 - error: No parameter named "_1" (reportCallIssue)
+namedtuples_define_functional.py:69:1 - error: Argument missing for parameter "a" (reportCallIssue)
 """
-conformance_automated = "Pass"
+conformance_automated = "Fail"
 errors_diff = """
+Line 59: Unexpected errors ['namedtuples_define_functional.py:59:33 - error: Named tuple field names cannot start with an underscore (reportGeneralTypeIssues)']
+Line 60: Unexpected errors ['namedtuples_define_functional.py:60:13 - error: No parameter named "_1" (reportCallIssue)']
 """
diff --git a/conformance/results/results.html b/conformance/results/results.html
index c632a117..79ecbdd8 100644
--- a/conformance/results/results.html
+++ b/conformance/results/results.html
@@ -915,11 +915,11 @@ <h3>Python Type System Conformance Test Results</h3>
 <th class="column col2 partially-conformant"><div class="hover-text">Partial<span class="tooltip-text" id="bottom"><p>Does not reject override of named tuple attribute in child class.</p></span></div></th>
 <th class="column col2 conformant">Pass</th>
 <th class="column col2 partially-conformant"><div class="hover-text">Partial<span class="tooltip-text" id="bottom"><p>Does not reject override of named tuple attribute in child class.</p></span></div></th>
-<th class="column col2 conformant">Pass</th>
+<th class="column col2 partially-conformant"><div class="hover-text">Partial<span class="tooltip-text" id="bottom"><p>Doesn't catch illegal field name starting with underscore</p></span></div></th>
 </tr>
 <tr><th class="column col1">&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;namedtuples_define_functional</th>
 <th class="column col2 conformant">Pass</th>
-<th class="column col2 conformant">Pass</th>
+<th class="column col2 partially-conformant">Partial</th>
 <th class="column col2 conformant">Pass</th>
 <th class="column col2 conformant">Pass</th>
 </tr>
diff --git a/conformance/results/zuban/namedtuples_define_class.toml b/conformance/results/zuban/namedtuples_define_class.toml
index 397c708f..67acdb24 100644
--- a/conformance/results/zuban/namedtuples_define_class.toml
+++ b/conformance/results/zuban/namedtuples_define_class.toml
@@ -4,7 +4,8 @@ Does not reject override of named tuple attribute in child class.
 """
 conformance_automated = "Fail"
 errors_diff = """
-Line 79: Expected 1 errors
+Line 106: Expected 1 errors
+Line 59: Unexpected errors ['namedtuples_define_class.py:59: error: Invalid statement in NamedTuple definition; expected "field_name: field_type [= default]"  [misc]']
 """
 output = """
 namedtuples_define_class.py:32: error: Tuple index out of range  [misc]
@@ -15,7 +16,10 @@ namedtuples_define_class.py:46: error: Argument 2 to "Point" has incompatible ty
 namedtuples_define_class.py:47: error: Argument "units" to "Point" has incompatible type "int"; expected "str"  [arg-type]
 namedtuples_define_class.py:48: error: Too many arguments for "Point"  [call-arg]
 namedtuples_define_class.py:49: error: Unexpected keyword argument "other" for "Point"  [call-arg]
-namedtuples_define_class.py:59: error: Non-default NamedTuple fields cannot follow default fields  [misc]
-namedtuples_define_class.py:98: error: Argument 2 to "Property" has incompatible type "float"; expected "str"  [arg-type]
-namedtuples_define_class.py:105: error: NamedTuple should be a single base  [misc]
+namedtuples_define_class.py:59: error: Invalid statement in NamedTuple definition; expected "field_name: field_type [= default]"  [misc]
+namedtuples_define_class.py:69: error: Too many arguments for "Point2"  [call-arg]
+namedtuples_define_class.py:76: error: NamedTuple field name cannot start with an underscore: _y  [misc]
+namedtuples_define_class.py:86: error: Non-default NamedTuple fields cannot follow default fields  [misc]
+namedtuples_define_class.py:125: error: Argument 2 to "Property" has incompatible type "float"; expected "str"  [arg-type]
+namedtuples_define_class.py:132: error: NamedTuple should be a single base  [misc]
 """
diff --git a/conformance/results/zuban/namedtuples_define_functional.toml b/conformance/results/zuban/namedtuples_define_functional.toml
index 5a604166..98ee2d2f 100644
--- a/conformance/results/zuban/namedtuples_define_functional.toml
+++ b/conformance/results/zuban/namedtuples_define_functional.toml
@@ -13,5 +13,6 @@ namedtuples_define_functional.py:43: error: Argument "x" to "Point6" has incompa
 namedtuples_define_functional.py:52: error: "namedtuple()" has duplicate field name "a"  [misc]
 namedtuples_define_functional.py:53: error: "namedtuple()" field name "def" is a keyword  [misc]
 namedtuples_define_functional.py:54: error: "namedtuple()" field name "def" is a keyword  [misc]
-namedtuples_define_functional.py:66: error: Missing positional argument "a" in call to "NT5"  [call-arg]
+namedtuples_define_functional.py:55: error: "namedtuple()" field name "_d" starts with an underscore  [misc]
+namedtuples_define_functional.py:69: error: Missing positional argument "a" in call to "NT7"  [call-arg]
 """
diff --git a/conformance/tests/namedtuples_define_class.py b/conformance/tests/namedtuples_define_class.py
index e345a197..5e6e9c4c 100644
--- a/conformance/tests/namedtuples_define_class.py
+++ b/conformance/tests/namedtuples_define_class.py
@@ -49,6 +49,33 @@ class Point(NamedTuple):
 p10 = Point(1, 2, "", other="")  # E
 
 
+# > Fields must be annotated attributes - methods and un-annotated attributes are not
+# > considered fields.
+
+
+class Point2(NamedTuple):
+    x: int
+    y: int
+    units = "meters"  # Not a field
+
+    def is_origin(self) -> int:  # Not a field
+        return self.x == 0 and self.y == 0
+
+
+p11 = Point2(1, 2)
+assert_type(p11, Point2)
+x, y = p11
+
+p12 = Point2(1, 2, "")  # E
+
+
+# > Field names may not start with an underscore.
+
+class Point3(NamedTuple):
+    x: int
+    _y: int  # E: illegal field name
+
+
 # > The runtime implementation of ``NamedTuple`` enforces that fields with default
 # > values must come after fields without default values. Type checkers should
 # > likewise enforce this restriction::
diff --git a/conformance/tests/namedtuples_define_functional.py b/conformance/tests/namedtuples_define_functional.py
index 432dff73..49f7c1b0 100644
--- a/conformance/tests/namedtuples_define_functional.py
+++ b/conformance/tests/namedtuples_define_functional.py
@@ -43,24 +43,27 @@
 p6_4 = Point6(x=1.1, y=2)  # E
 
 
-# > At runtime, the ``namedtuple`` function disallows field names that are
-# > illegal Python identifiers and either raises an exception or replaces these
-# > fields with a parameter name of the form ``_N``. The behavior depends on
-# > the value of the ``rename`` argument. Type checkers may replicate this
-# > behavior statically.
+# > At runtime, the ``namedtuple`` function disallows field names that begin with
+# > an underscore or are illegal Python identifiers, and either raises an exception
+# > or replaces these fields with a parameter name of the form ``_N``. The behavior
+# > depends on the value of the ``rename`` argument. Type checkers may replicate
+# > this behavior statically.
 
 NT1 = namedtuple("NT1", ["a", "a"])  # E?: duplicate field name
 NT2 = namedtuple("NT2", ["abc", "def"])  # E?: illegal field name
 NT3 = namedtuple("NT3", ["abc", "def"], rename=False)  # E?: illegal field name
+NT4 = namedtuple("NT4", ["abc", "_d"], rename=False)  # E?: illegal field name
 
-NT4 = namedtuple("NT4", ["abc", "def"], rename=True)  # OK
-NT4(abc="", _1="")  # OK
+NT5 = namedtuple("NT5", ["abc", "def"], rename=True)  # OK
+NT5(abc="", _1="")  # OK
+NT6 = namedtuple("NT6", ["abc", "_d"], rename=True)  # OK
+NT6(abc="", _1="")  # OK
 
 
 # > The ``namedtuple`` function also supports a ``defaults`` keyword argument that
 # > specifies default values for the fields. Type checkers may support this.
 
-NT5 = namedtuple("NT5", "a b c", defaults=(1, 2))
-NT5(1)  # OK
-NT5(1, 2, 3)  # OK
-NT5()  # E: too few arguments
+NT7 = namedtuple("NT7", "a b c", defaults=(1, 2))
+NT7(1)  # OK
+NT7(1, 2, 3)  # OK
+NT7()  # E: too few arguments
diff --git a/docs/spec/namedtuples.rst b/docs/spec/namedtuples.rst
index 1ac14136..936d2fa7 100644
--- a/docs/spec/namedtuples.rst
+++ b/docs/spec/namedtuples.rst
@@ -20,6 +20,14 @@ Type checkers should support the class syntax::
         y: int
         units: str = "meters"
 
+Fields must be annotated attributes - methods and un-annotated attributes are not
+considered fields. Field names may not start with an underscore.
+
+    class MyTuple(NamedTuple):
+        x1 = 1  # Not a field
+        def x2() -> None: pass  # Not a field
+        _x3: int  # Type error: illegal field name
+
 Regardless of whether the class syntax or factory function call is used to define
 a named tuple, type checkers should synthesize a ``__new__`` method based on
 the named tuple fields. This mirrors the runtime behavior. In the example
@@ -79,17 +87,21 @@ A type checker may support the factory function call in its various forms::
     Point5 = NamedTuple('Point5', [('x', int), ('y', int)])
     Point6 = NamedTuple('Point6', (('x', int), ('y', int)))
 
-At runtime, the ``namedtuple`` function disallows field names that are
-illegal Python identifiers and either raises an exception or replaces these
-fields with a parameter name of the form ``_N``. The behavior depends on
-the value of the ``rename`` argument. Type checkers may replicate this
-behavior statically::
+At runtime, the ``namedtuple`` function disallows field names that begin with
+an underscore or are illegal Python identifiers, and either raises an exception
+or replaces these fields with a parameter name of the form ``_N``. The behavior
+depends on the value of the ``rename`` argument. Type checkers may replicate
+this behavior statically::
 
     NT1 = namedtuple("NT1", ["a", "a"])  # Type error (duplicate field name)
     NT2 = namedtuple("NT2", ["abc", "def"], rename=False)  # Type error (illegal field name)
+    NT3 = namedtuple("NT3", ["abc", "_d"], rename=False)  # Type error (illegal field name)
+
+    NT4 = namedtuple("NT4", ["abc", "def"], rename=True)  # OK
+    NT4(abc="", _1="")  # OK
 
-    NT3 = namedtuple("NT3", ["abc", "def"], rename=True)  # OK
-    NT3(abc="", _1="")  # OK
+    NT5 = namedtuple("NT5", ["abc", "_d"], rename=True)  # OK
+    NT5(abc="", _1="")  # OK
 
 The ``namedtuple`` function also supports a ``defaults`` keyword argument that
 specifies default values for the fields. Type checkers may support this::