The challenge is played as Isaac, who starts with Mom's Box, Marbles, and Mom's Purse, resulting in 4 random trinkets spawned on the floor in the starting room. All item pedestals, including those ones from Devil Rooms, Shops, Libraries, etc., are replaced with trinket drops. It is, however, still possible to see a few item pedestals in this challenge.
Unlike its usual function, Marbles now causes Isaac to swallow his held trinkets every time he takes damage, rather than having a low chance of occurring. This allows building up a large collection of trinkets, quite easily making up for the lack of regular items. However, this has its downsides - some trinkets on their own or in combination with others can have undesirable or even disastrous results, such as wild teleportation or spontaneous explosions. If there is any uncertainty, looking up the trinket before committing to it by having it swallowed is recommended.
Certain Trinkets are much more valuable than others at the beginning of a run, especially since Mom's Box, Isaac's starting active item in this run, doubles the effects of most Trinkets. Since four Trinkets are given to you to start with, it may be useful to restart until you find one (or more) of the following:
- Cancer - a reliable tears up.
- Curved Horn - a massive damage up.
- Crystal Key - gives more opportunities to charge Mom's Box, giving you more Trinkets.
- Isaac's Fork - helps regain health lost from gulping trinkets.
- Number Magnet - makes Devil Rooms more common.
- Mother's Kiss - adds 2 more heart containers which are normally unobtainable.
- Maggy's Faith - gives a heart container each floor.
Items can still be obtained through rerolling key pieces.
- In this challenge, every trinket is unlocked. This allows the player to see new trinkets they still have to unlock.
- Picking up trinkets spawned in the Boss Rush room will not start the Boss Rush.
- Items created by Wish Bone and Bag Lunch are not replaced with trinkets.
- Modeling Clay does not display the item it is in the item section. Keep this in mind if you chose to keep it.
- Pica is a psychological disorder where a person experiences a compulsion to eat inedible objects and substances.
|Mom's Heart Unlocks|
|1. Pitch Black||2. High Brow||3. Head Trauma||4. Darkness Falls||5. The Tank|
|6. Solar System||7. Suicide King||8. Cat Got Your Tongue||9. Demo Man||10. Cursed!|
|11. Glass Cannon||12. When Life Gives You Lemons||13. Beans!||14. It's in the Cards||15. Slow Roll|
|16. Computer Savvy||17. Waka Waka||18. The Host||19. The Family Man||20. Purist|
|21. XXXXXXXXL||22. SPEED!||23. Blue Bomber||24. PAY TO PLAY||25. Have a Heart|
|26. I RULE!||27. BRAINS!||28. PRIDE DAY!||29. Onan's Streak||30. The Guardian|
|31. Backasswards||32. Aprils Fool||33. Pokey Mans||34. Ultra Hard||35. Pong|
|36. Scat Man||37. Bloody Mary||38. Baptism by Fire||39. Isaac's Awakening||40. Seeing Double|
|41. Pica Run||42. Hot Potato||43. Cantripped!||44. Red Redemption||45. DELETE THIS|
|The Binding of Isaac: Rebirth|
|Achievements||Attributes||Bosses||Cards and Runes||Challenges||Chapters|