The Binding of Isaac: Afterbirth

This article is incomplete. Please help to improve it, or discuss the issue on the talk page. Issues: Incomplete list of additions and changes.

The Binding of Isaac: Afterbirth is the expansion to The Binding of Isaac: Rebirth. The DLC was released on October 30, 2015 and costs $10.99/£7.99. It was released on May 10, 2016 on Xbox One and PS4.

For a list of the pre-release blog posts, see The Binding of Isaac: Afterbirth (Pre-Release).

Features

• Greed Mode: A new game mode with a heavy focus on risk/reward, featuring a new ending and final boss.
• Blue Womb: A new area, featuring a new ending and final boss.
• Daily Runs: Daily seeded runs with online leaderboards.
• Two new characters, Lilith and Keeper.
• 95 new items and 29 new trinkets.
• New pickups, chests, pills, and cards.
• 10 new challenges.
• 4 new alternate chapters: Burning Basement, Flooded Caves, Dank Depths, and Scarred Womb.
• Many new room layouts including tiny rooms, long hallways, and L-shaped rooms.
• New room types like trap rooms, double treasure rooms, and closets.
• New special seeds, along with a seed code combo page.
• An expanded soundtrack.
• An extra HUD option, allowing items picked up to be displayed on-screen.
• 9 new transformations.
• New bosses, along with new variations of bosses introduced in Rebirth.
• New monsters.
• Updated item combo system.
• New achievements.
• New co-op babies.
• An improved collection page that shows item descriptions.

Additions

Player

Characters

Character	Lilith	Keeper
Health
Damage	3.5 (*1.00)	3.5 (*1.20)
Tears	Blindfolded (+0)	+18
Shot Speed	Blindfolded (1)	1
Range	Blindfolded (23.75)	23.75
Speed	1.0	0.85
Luck	0	-2
Starting Pickup(s)	None	x1 bombs x1 coins Store Key
Starting Item(s)	Incubus Cambion Conception Box of Friends	Triple shot Wooden Nickel

Transformations

Name	Appearance	Description
Bob		Isaac gains a green trail of poisonous creep.
Conjoined		When attacking, the tumor faces shoot tears diagonally outwards, similar to the effect of The Wiz. Also gives -0.3 damage and slightly decreases tears.
Fun Guy		+1 Red Heart container.
Leviathan		Grants flight and gives +2 black hearts.
Oh Crap		Whenever a pile of poop is destroyed, health is replenished by half a heart.
Seraphim		Grants flight and gives +3 soul hearts.
Spun		Gives +2 damage and +0.15 speed, and spawns a random pill upon transformation.
Super Bum		Replaces Bum Friend, Dark Bum, and Key Bum for Super Bum. This bum collects any of the other beggars' pickups, and offers twice the rewards.
Yes Mother?		Isaac gains a stationary knife that trails directly behind him. It synergizes like Mom's Knife would.

Co-op

Special Babies

These Babies have special bonuses that will aid the player in some way.

ID	Appearance	Name	Description
27		Black Baby	Spawns with an extra black heart. Defeat Mega Satan as Azazel to unlock it.
28		Red Baby	Spawns with an extra red heart. Defeat Mega Satan as Magdalene to unlock it.
29		White Baby	Gives Isaac an eternal heart when it spawns. Defeat Mega Satan as The Lost to unlock it.
30		Blue Baby	Spawns with an extra soul heart. Defeat Mega Satan as ??? to unlock it.
31		Rage Baby	Occasionally briefly increases Isaac's damage. Defeat Mega Satan as Samson to unlock it.
32		Cry Baby	Occasionally briefly increases Isaac's tears. Defeat Mega Satan as Isaac to unlock it.
33		Yellow Baby	Occasionally briefly increases Isaac's speed by 0.15. Defeat Mega Satan as Eden to unlock it.
34		Long Baby	Occasionally briefly increases Isaac's range, shot speed, and tear height. Defeat Mega Satan as Lazarus to unlock it.
35		Green Baby	Occasionally briefly increases Isaac's luck by 2. Defeat Mega Satan as Cain to unlock it.
36		Lil' Baby	Occasionally briefly decreases Isaac's size. Defeat Mega Satan as Eve to unlock it.
37		Big Baby	Occasionally briefly increases Isaac's size. Defeat Mega Satan as Lilith to unlock it.
38		Brown Baby	Occasionally briefly gives Isaac the Butt Penny effect. While it is active, picking up a coin will make Isaac fart, knocking back nearby enemies. Defeat Mega Satan as Judas to unlock it.
39		Noose Baby	Occasionally briefly gives Isaac the Transcendence effect, granting flight. Defeat Mega Satan as Keeper to unlock it.
40		Hive Baby	Occasionally briefly gives Isaac the Hive Mind effect, doubling the damage dealt by blue spiders and blue flies. Earn all Hard mode completion marks as ??? to unlock it.
41		Buddy Baby	Occasionally briefly gives Isaac the Guillotine effect, detaching Isaac's head and increasing damage and tears. Earn all Hard mode completion marks as Isaac to unlock it.
42		Colorful Baby	Upon joining, fully heals Isaac, similar to the rainbow poop effect. Earn all Hard mode completion marks as Magdalene to unlock it.
43		Whore Baby	Occasionally briefly gives Isaac the Whore of Babylon effect, increasing damage and speed. Earn all Hard mode completion marks as Eve to unlock it.
44		Cracked Baby	Earn all Hard mode completion marks as Eden to unlock it.
45		Dripping Baby	Occasionally briefly gives Isaac Anemic, increasing range by 5 and causing Isaac to leave a trail of blood that damages enemies. Earn all Hard mode completion marks as Lazarus to unlock it.
46		Blinding Baby	Upon death, activates the effect of XIX - The Sun, fully restoring Isaac's red hearts, deals 100 damage to all enemies in the room, and revealing the map for the current floor. Use Blank Card while holding XIX - The Sun to unlock it.
47		Sucky Baby	Has an aura around itself that damages enemies while they are inside, similar to Succubus. Earn all Hard mode completion marks as Azazel to unlock it.
48		Dark Baby	Occasionally provides a brief boost to all of Isaac's stats. Earn all Hard mode completion marks as Lilith to unlock it.
49		Picky Baby	Earn all Hard mode completion marks as Cain to unlock it.
50		Revenge Baby	Occasionally briefly increases Isaac's damage. Earn all Hard mode completion marks as Samson to unlock it.
51		Belial Baby	Occasionally briefly gives Isaac the The Book of Belial effect, increasing damage. Earn all Hard mode completion marks as Judas to unlock it.
52		Sale Baby	Occasionally briefly gives Isaac the Steam Sale effect, halving the prices of all shop items. Earn all Hard mode completion marks as Keeper to unlock it.
53		Goat Head Baby	Occasionally briefly gives Isaac the Goat Head effect, guaranteeing that a Devil room or angel room will open if a boss room is completed while the effect is active. Defeat Mom's Heart on Hard mode as Lilith to unlock it.
54		Super Greed Baby	Has the Head of the Keeper effect, firing coin tears that have a chance to spawn a coin upon hitting an enemy. Defeat Mom's Heart on Hard mode as Keeper to unlock it.

Normal Babies

These Babies are purely cosmetic and do not have any special behaviors.

ID	Appearance	Name	Description
233		Punkboy Baby	A baby dressed as a punk rocker boy.
234		Punkgirl Baby	A baby dressed as a punk rocker girl.
235		Computer Baby	A baby with a computer for a head.
236		Mask Baby	A baby wearing a mask.
237		Gem Baby	A baby that looks like it's made of crystal.
238		Shark Baby	A baby that looks like a shark.
239		Beret Baby	A baby that's wearing a beret.
240		Blisters Baby	A baby covered in blisters.
241		Radioactive Baby	A sickly green baby.
242		Beast Baby	A baby that looks like a beast.
243		Dark Baby	A very dark baby.
244		Snail Baby	A baby that looks like a snail.
245		Blood Baby	A baby that looks like a drop of blood.
246		8 Ball Baby	A baby with an 8 ball for a head.
247		Wisp Baby	A wispy baby.
248		Cactus Baby	A baby that looks like a cactus.
249		Love Eye Baby	A pink baby with a heart for an eye.
250		Medusa Baby	A baby that resembles Medusa.
251		Nuclear Baby	A baby that looks like a mushroom cloud.
252		Purple Baby	A strange purple baby.
253		Wizard Baby	A baby with a wizard hat.
254		Earth Baby	A baby whose head looks like planet Earth.
255		Saturn Baby	A baby with a ring around its head.
256		Cloud Baby	A baby made of cloud.
257		Tube Baby	A baby with a tube connecting both eyes.
258		Rocker Baby	A baby dressed as a rock fan.
259		King Baby	A baby with a crown.
260		Coat Baby	A baby wearing a winter coat.
261		Viking Baby	A baby with a Viking helmet.
262		Panda Baby	A baby that looks like a panda.
263		Raccoon Baby	A baby that looks like a raccoon.
264		Bear Baby	A baby that looks like a grizzly bear.
265		Polar Bear Baby	A baby that looks like a polar bear.
266		Lovebear Baby	A baby that looks like a Care Bear.
267		Hare Baby	A baby that looks like a rabbit.
268		Squirrel Baby	A baby that looks like a squirrel.
269		Tabby Baby	A baby that looks like a cat.
270		Porcupine Baby	A baby that looks like a porcupine.
271		Puppy Baby	A baby that looks like a puppy.
272		Parrot Baby	A baby that looks like a parrot.
273		Chameleon Baby	A baby that looks like a Chameleon.
274		Boulder Baby	A baby made of rocks.
275		Aqua Baby	An aqua-blue baby.
276		Gargoyle Baby	A baby that resembles a gargoyle.
277		Spiky Demon Baby	A baby that looks like a spiky demon.
278		Red Demon Baby	A baby that looks like a red demon.
279		Orange Demon Baby	A baby that looks like an orange demon.
280		Eye Demon Baby	A baby with an eye for a head.
281		Fang Demon Baby	A baby with big fangs.
282		Ghost Baby	A baby that looks like a ghost.
283		Arachnid Baby	A baby that looks like a spider.
284		Bony Baby	A baby that looks like a Bony.
285		Big Tongue Baby	A baby with a big tongue.
286		3D Baby	A baby wearing 3D glasses.
287		Suit Baby	A baby in a nice suit.
288		Butt Baby	A baby with a butt for a face.
289		Cupid Baby	A baby that looks like Cupid.
290		Heart Baby	A baby with a heart-shaped head.
291		Killer Baby	A baby that looks like Jason Voorhees from the "Friday the 13th" horror movie series.
292		Lantern Baby	A baby that looks like Ash Williams from the Evil Dead series.
293		Banshee Baby	A baby that looks like a banshee.
294		Ranger Baby	A baby that looks like a Red Power Ranger.
295		Rider Baby	A baby that looks like a Kamen Rider.
296		Choco Baby	A baby made of chocolate.
297		Woodsman Baby	A baby dressed as a hiker.
298		Brunette Baby	A baby with brown hair
299		Blonde Baby	A baby with blonde hair.
300		Blue Hair Baby	A baby with blue hair
301		Bloodied Baby	A baby covered in blood.
302		Cheese Baby	A baby made of cheese.
303		Pizza Baby	A baby made of pizza.
304		Hotdog Baby	A baby that is also a hotdog.
305		Nature Baby	A naked baby with a leaf.
306		Borg Baby	A robotic baby.
307		Corrupted Baby	A baby with seems to be covered by an alien life.
308		X Mouth Baby	A gagged baby.
309		X Eyed Baby	A comically dead baby.
310		Starry Eyed Baby	A baby with starry eyes.
311		Surgeon Baby	A baby ready for surgery.
312		Sword Baby	A baby that's a sword.
313		Monk Baby	A baby that's a monk.
314		Disco Baby	A funky baby with an afro
315		Puzzle Baby	A baby with a "Rubik's Cube" for a head
316		Speaker Baby	A baby that has a speaker for a head.
317		Scary Baby	A baby that resembles Jeff the Killer.
318		Fireball Baby	A fireball with eyes. Possibly a reference to the fire enemy in the Donkey Kong and Mario games.
319		Maw Baby	A baby that's just a mouth.
320		Exploding Baby	A baby that's a bomb.
321		Cupcake Baby	A baby that's also a cupcake.
322		Skinless Baby	A baby without skin.
323		Ballerina Baby	A baby wearing a tutu.
324		Goblin Baby	A baby that resembles a goblin.
325		Cool Goblin Baby	A green baby with brown hair and cool shades.
326		Geek Baby	A baby with black hair and nerdy glasses.
327		Long Beard Baby	A baby with a long beard.
328		Muttonchops Baby	A baby with muttonchops.
329		Spartan Baby	A baby that resembles King Leonidas from 300.
330		Tortoise Baby	A baby that looks like a tortoise.
331		Slicer Baby	A baby that resembles Shredder.
332		Butterfly Baby	A baby with butterfly wings.
333		Homeless Baby	A baby that resembles a homeless person.
334		Lumberjack Baby	A baby that resembles a lumberjack.
335		Cyberspace Baby	A baby that resembles something from the Tron universe.
336		Hero Baby	A baby that resembles Red from Gunstar Heroes.
337		Boxers Baby	A baby that resembles Arthur from Ghosts & Goblins (in his boxers).
338		Wing Helmet Baby	A baby that resembles Opa-Opa.
339		X Baby	A baby with an X for a head.
340		O Baby	A baby with an O for a head.
341		Vomit Baby	A baby with vomit coming from its mouth.
342		Merman Baby	A baby that resembles Aquaman.
343		Cyborg Baby	Might be a reference to a Cyborg from a novel/movie/game?
344		Barbarian Baby	A baby that resembles the Barbarian from Diablo.
345		Locust Baby	A baby that resembles a locust.
346		Twotone Baby	A completely white baby with a black outline.
347		2600 Baby	A baby that resembles an Atari 2600 sprite.
348		Fourtone Baby	A baby with a minimal colour sprite.
349		Grayscale Baby	A baby colored with several shades of gray.
350		Rabbit Baby	A baby that resembles Oswald the Lucky Rabbit.
351		Mouse Baby	A baby that resembles an old-style Mickey Mouse.
352		Critter Baby	A critter that looks white and hairy. Might be a reference to the movie Critters.
353		Blue Robot Baby	A baby that resembles Mega Man.
354		Pilot Baby	A baby that resembles Jason from Blaster Master.
355		Red Plumber Baby	A baby that resembles Mario.
356		Green Plumber Baby	A baby that resembles Luigi.
357		Yellow Plumber Baby	A baby that resembles Wario.
358		Purple Plumber Baby	A baby that resembles Waluigi.
359		Tanooki Baby	A baby that's wearing a Tanooki Suit.
360		Mushroom Man Baby	A baby that resembles Toad.
361		Mushroom Girl Baby	A baby that resembles Toadette.
362		Cannonball Baby	A baby that resembles a Chain Chomp.
363		Froggy Baby	A baby that's wearing a Frog Suit.
364		Turtle Dragon Baby	A baby that resembles Bowser.
365		Shell Suit Baby	A baby wearing a Hammer Suit.
366		Fiery Baby	A baby wearing a Fire Suit.
367		Mean Mushroom Baby	A baby that resembles a Goomba.
368		Arcade Baby	A baby that resembles Pac-Man.
369		Scared Ghost Baby	A blue ghost with a scared expression.
370		Blue Ghost Baby	A baby that resembles Inky.
371		Red Ghost Baby	A baby that resembles Blinky.
372		Pink Ghost Baby	A baby that resembles Pinky.
373		Orange Ghost Baby	A baby that resembles Clyde.
374		Pink Princess Baby	A baby that resembles Princess Peach.
375		Yellow Princess Baby	A baby that resembles Princess Daisy.
376		Dino Baby	A baby that resembles Yoshi.
377		Elf Baby	A baby that resembles Link.
378		Dark Elf Baby	A baby that resembles Dark Link
379		Dark Knight Baby	A baby that resembles a Darknut
380		Octopus Baby	A baby that resembles an Octorok.
381		Orange Pig Baby	A baby that resembles an orange Moblin.
382		Blue Pig Baby	A baby that resembles a blue Moblin.
383		Elf Princess Baby	A baby that resembles Princess Zelda.
384		Fishman Baby	A baby that resembles a Zora.
385		Fairyman Baby	A baby that resembles Tingle.
386		Imp Baby	A baby that resembles Midna.
387		Worm Baby	A baby that resembles Earthworm Jim.
388		Blue Wrestler Baby	A baby that looks like the blue player in Smash TV.
389		Red Wrestler Baby	A baby that looks like the red player in Smash TV.
390		Toast Baby	A baby that resembles Powdered Toast Man.
391		Roboboy Baby	A baby that resembles Astro Boy.
392		Liberty Baby	A baby that resembles the Statue of Liberty.
393		Dream Knight Baby	A baby that resembles Meta Knight.
394		Cowboy Baby	A baby that's wearing a cowboy outfit.
395		Mermaid Baby	A baby that resembles Ariel.
396		Plague Baby	A baby wearing a plague doctor outfit.
397		Space Soldier Baby	A baby that resembles a Warhammer 40k Space Marine.
398		Dark Space Soldier Baby	A baby that resembles a Warhammer 40k Chaos Space Marine.
399		Gas Mask Baby	A baby that's wearing a gas mask.
400		Tomboy Baby	A baby that resembles Sheik from the Legend of Zelda franchise.
401		Corgi Baby	A baby that looks like a corgi.
402		Unicorn Baby	A baby that looks like a unicorn.
403		Pixie Baby	A baby that resembles Tinkerbell.
404		Referee Baby	A baby wearing a referee outfit.
405		Deal With It Baby	A baby with a goatee and sunglasses.
406		Astronaut Baby	A baby that's wearing an astronaut outfit.
407		Blurred Baby	A baby with a blur effect across its privates.
408		Censored Baby	A baby with a censor bar across its privates.
409		Cool Ghost Baby	A baby that resembles the character Shades (Sukezaemon) from Ufouria: The Saga.
410		Gills Baby	A baby that resembles the character Gil (Jennifer) from Ufouria: The Saga.
411		Blue Hat Baby	A baby that resembles the character Bop-Louie (Hebe) from Ufouria: The Saga.
412		Catsuit Baby	A baby that's wearing a cat outfit. Also resembles the character Oh-Chan from Ufouria: The Saga (Japanese version).
413		Pirate Baby	A baby that's wearing a pirate outfit.
414		Super Robo Baby	A baby that resembles Tekkaman the Space Knight.
415		Lightmage Baby	A baby that resembles the white mage class from Final Fantasy.
416		Puncher Baby	A baby that resembles the warrior class from Final Fantasy.
417		Holy Knight Baby	A baby that resembles the monk class from Final Fantasy.
418		Shadowmage Baby	A baby that resembles the black mage class from Final Fantasy.
419		Firemage Baby	A baby that resembles the red mage class from Final Fantasy.
420		Priest Baby	A baby that's wearing a priest outfit.
421		Zipper Baby	A baby with a zipped mouth.
422		Bag Baby	A baby with a bag over its head.
423		Sailor Baby	A baby that's wearing a sailor outfit.
424		Rich Baby	A baby with a top hat and monocle.
425		Toga Baby	A baby in an ancient Roman outfit.
426		Knight Baby	A baby that resembles a Darknut from The Legend of Zelda.
427		Black Knight Baby	A baby that resembles a black Darknut from The Legend of Zelda.

Items

95 new items were added in the expansion: 19 activated items and 76 passive items.

Activated Collectibles

Name	ID	Icon	Quote	Description	Quality
Box of Friends	5.100.357		Double your friends	Duplicates all of Isaac's familiars for the current room. If Isaac has no familiars, spawns a Demon Baby for the room instead.	1
D12	5.100.386		Rerolls rocks	Re-rolls all rocks in the current room into other random objects, such as bomb rocks, metal blocks, TNT, or poops.	0
D7	5.100.437		Roll again	Restarts the current room and brings back all enemies, allowing more rewards to be acquired by completing the room.	1
D8	5.100.406		Reroll stats	Re-rolls Isaac's damage, tears, range, and speed.	2
Diplopia	5.100.347		Double item vision	Duplicates all pickups and item pedestals in the room.	3
Friendly Ball	5.100.382		Gotta fetch 'em all!	Throwing the ball at a monster instantly kills and captures it. The captured enemy can later be released and will be friendly, fighting for Isaac and persisting between rooms.	1
Glass Cannon	5.100.352		Be gentle...	Fires a high-damage piercing spectral tear, but lowers Isaac's health to half a heart. Fires a high-damage piercing spectral tear. If Isaac takes damage while holding this, he takes extra damage and it becomes Broken Glass Cannon.	1
Glowing Hour Glass	5.100.422		Turn back time	When used, this item will rewind time, put Isaac back in the previous room, and undo anything that happened in the current room. Any health, pickups, or items gained or lost will be reset back to the previous state.	1
Jar of Flies	5.100.434		Bug catcher	Killing an enemy adds a fly to the jar, up to a maximum of 20. On use, releases Blue Flies equal to the number of flies in the jar.	2
Kidney Bean	5.100.421		Love toots!	Isaac farts, charming all nearby enemies.	0
Mega Bean	5.100.351		Giga fart!	Petrifies all enemies in the current room for a couple of seconds, poisons any enemies near Isaac, and sends a rock wave across the room in the direction Isaac is facing.	1
Mega Blast	5.100.441		Laser breath	Upon use, Isaac fires a laser similar to the one used by Mega Satan. This laser deals massive damage, lasts for approximately 15 seconds, and persists between rooms. Isaac is pushed backwards by the force of the laser while it is active.	4
Mine Crafter	5.100.427		Booom!	Places an explosive TNT barrel that can be pushed and used to destroy rocks or damage enemies when used. If used a second time in the same room while the previous TNT barrel is still intact, it will remotely explode the TNT.	1
Mom's Box	5.100.439		What's inside?	Passively increases luck by 1 and doubles the effects of trinkets while held. When used, drops a random trinket on the ground.	3
Placebo	5.100.348		Pill mimic	When used, copies the effect of the pill Isaac is currently holding without consuming it. Does not copy the effects of cards or runes.	2
Tear Detonator	5.100.383		Remote tear detonation!	When used, will detonate any tears currently on the screen and cause each one to split into 6 more tears which will fire in a circle, similar to Tammy's Head.	1
Teleport 2.0	5.100.419		I-Teleport!	Teleports Isaac to a random room that has not been explored yet when used. If all rooms are explored, including secret rooms, it will teleport Isaac to the Devil or Angel room. If all rooms are explored, including the Devil or Angel room, it will teleport Isaac to the I AM ERROR room. If used in a room with enemies, it will teleport Isaac out and back into the same room.	2
Ventricle Razor	5.100.396		Short cutter	Can be used to place an orange portal and a blue portal. Upon entering a portal, Isaac is teleported to the other portal.	1
Wooden Nickel	5.100.349		Flip a coin	When used, has a 50% chance to drop one random type of coin (Penny, Nickel, or Dime).	1

Passive Collectibles

Name	ID	Icon	Quote	Description	Quality
8 Inch Nails	5.100.359		Stick it to 'em!	+1.5 damage. Replaces Isaac's tears with nails, which have increased knockback.	3
Athame	5.100.408		Call to the void	When Isaac takes damage, a black ring briefly appears around him, dealing damage to all nearby enemies.	2
Betrayal	5.100.391		Turn your enemy	Every time Isaac takes damage, a charm effect is applied to every enemy in the room, causing them to attack each other rather than Isaac.	0
Binky	5.100.438		Tears up	Grants one Soul Heart, +0.75 tears and decreases Isaac's size.	3
Black Powder	5.100.420		Spin the black circle!	Isaac leaves a trail of black powder on the floor. Walking in a circle will spawn a pentagram symbol on the floor, which deals 10 damage per tick to any enemies inside it.	1
Bomber Boy	5.100.353		Cross blast + 5 bombs	+5 bombs. Isaac's bombs will now explode in a large cross-shaped pattern (roughly 5 bombs explosions wide). This also affects player-spawned Troll Bombs.	2
Bumbo	5.100.385		Bumbo want coin!	Spawns a beggar familiar which picks up any nearby coins, leveling up after collecting several coins. At level 2, Bumbo gains a body. At level 3, it begins to fire tears. At level 4, Bumbo follows enemies and gains contact damage.	1
Bursting Sack	5.100.377		Spider love	Spider enemies no longer target or deal contact damage to Isaac.	1
Cambion Conception	5.100.412		Feed them hate	After taking damage a certain amount of times, a permanent demonic familiar spawns.	2
Car Battery	5.100.356		Active power up	Causes Isaac's activated item to activate twice on each use.	3
Censer	5.100.387		Peace be with you	Spawns a familiar which creates a circular aura that slows down enemies and enemy shots inside.	3
Chaos	5.100.402		!!!	Drops 1-6 random pickups on the floor. Causes items to be chosen from random item pools.	3
Charged Baby	5.100.372		Bbbzzzzzt!	Spawns a familiar that occasionally drops a Lil' Battery, gives an active item charge, or petrifies all enemies in the room.	3
Circle of Protection	5.100.423		Protect me from myself	Surrounds Isaac with a large white halo that occasionally deals Isaac's tear damage to enemies inside it, and can convert enemy shots into friendly homing tears.	1
Continuum	5.100.369		Transcendent tears	Grants spectral tears and increases range. Tears travel through walls and appear at the opposite side of the room.	2
Crack Jacks	5.100.354		HP up. Don't swallow the prize!	Grants one full Red Heart container and drops a random trinket.	2
Crown of Light	5.100.415		The untainted gain power	+2 soul hearts. While Isaac has no empty red hearts, grants 2x damage, +5.25 range, and -0.3 shot speed. Regardless of health, the crown deactivates for the current room when Isaac takes damage.	4
Curse of the Tower	5.100.371		Embrace chaos	Upon taking damage, spawns six Troll Bombs around the room, similar to the effect of XVI - The Tower.	1
Dead Eye	5.100.373		Accuracy brings power!	Isaac's damage increases each time an enemy is hit. Damage is reset upon missing a shot.	3
Deep Pockets	5.100.416		More money!	Allows Isaac to carry two cards or pills (or a combination of both) at the same time. Increases the coin cap to 999. If a room would otherwise yield no reward, 1-3 coins will spawn.	2
Eden's Blessing	5.100.381		Tears up + your future shines brighter	+0.7 tears up. Grants a random item at the start of the next run.	3
Empty Vessel	5.100.409		I reward an empty vessel	Grants two Black Hearts. While Isaac has no red hearts, grants flight and periodically grants an invincibility shield for a few seconds.	2
Epiphora	5.100.368		Intensifying tears	Shooting in one direction increases Isaac's rate of fire until the cap is reached. As soon as Isaac changes direction or stops shooting, rate of fire is reset to its normal amount.	1
Evil Eye	5.100.410		Eye shot!	While firing tears, Isaac has a chance to fire an eye across the screen with a very slow shot speed, which will fire tears of its own in the same direction as Isaac. The eye will be destroyed if it comes into contact with an enemy or obstacle.	2
Explosivo	5.100.401		Sticky bomb shot!	Isaac's tears have a chance to stick to enemies and explode.	1
Farting Baby	5.100.404		He farts!	Spawns a familiar that follows Isaac and blocks enemy shots. If a shot hits Farting Baby, it has a chance to fart, which charms, poisons, or knocks back nearby enemies.	1
Fate's Reward	5.100.361		Your fate beside you	A blue head familiar that will follow Isaac and fire tears copying his tear effects and damage.	2
Friend Zone	5.100.364		Friendly fly	Spawns a white attack fly that orbits somewhere between Distant Admiration and Forever Alone, dealing 45 damage per second.	1
Fruit Cake	5.100.418		Rainbow effects!	Isaac's tears gain a random effect that changes every shot.	2
GB Bug	5.100.405		Double tap glitch	Spawns a familiar that bounces diagonally around the room, applying a random status effect to enemies it hits and has a chance to re-roll pickups it passes over. Spawns a familiar that follows Isaac. Double tapping the fire button launches it forward, causing it to reroll the first monster or pickup it hits.	0
Glitter Bombs	5.100.432		Prize bombs!	+5 bombs. Bombs have a chance to drop random pickups or charm enemies when they explode.	2
God's Flesh	5.100.398		Shrink shot!	Tears have a chance to shrink enemies, making them run away from Isaac. Shrunk enemies can be crushed and killed by walking over them.	1
Head of the Keeper	5.100.429		Penny tears!	Isaac's tears become coins and now have a chance to drop Pennies on the floor upon successfully hitting an enemy.	2
Holy Light	5.100.374		Holy death shot	Adds a chance to fire holy tears, which will create a damaging light beam in the area if they hit an enemy.	3
Host Hat	5.100.375		Blast resistance	A host familiar that sits on Isaac's head and has a random chance to block enemy shots and retaliate with 3 tears. Grants immunity to explosions.	3
Immaculate Conception	5.100.413		Feed them love	Upon picking up a certain amount of health, spawn a permanent angelic familiar.	1
Incubus	5.100.360		Dark friend	Spawns a demonic familiar that shoots tears identical to Isaac's in terms of damage, tears, and tear effects.	4
Key Bum	5.100.388		He wants your keys!	Spawns a familiar that follows Isaac and collects Keys for himself, giving random Chests in return.	0
Kidney Stone	5.100.440		Matt's kidney stone	Randomly while firing tears, Isaac will stop firing and turn red, where he will charge and release a lot of 'tears' in one go. The burst of tears also includes a kidney stone, which deals a lot of damage.	1
Lil Chest	5.100.362		What's in the box?	Spawns a chest familiar that spawns a random pickup (25% chance) or trinket (10% chance) upon clearing a room.	2
Lil Gurdy	5.100.384		A gurd of your own!	A Gurdy Jr. familiar that charges up while Isaac is firing, bouncing around the room when released and dealing contact damage based on its speed.	1
Lil Loki	5.100.435		4-way buddy!	Spawns a Loki familiar that follows Isaac and fires 4 tears in a cross pattern.	1
Lost Fly	5.100.365		Lost protector	Spawns fly familiar that moves in a straight line and circles around the first wall or obstacle it hits, dealing 105 damage per second on contact.	0
Lusty Blood	5.100.411		Their blood brings rage!	Isaac's damage increases for the current room each time he kills an enemy.	3
Marked	5.100.394		Directed tears	Isaac will automatically fire tears directed at a red target on the ground. The target can be moved with tear controls. +0.7 tears, +3.15 range.	0
Maw of the Void	5.100.399		Consume thy enemy!	Charged by firing for 2.5 seconds and when released, creates a black ring around Isaac that rapidly deals damage. +1 damage, the ring can cause enemies to drop Black Hearts.	4
Milk!	5.100.436		Don't cry over it...	Spawns a glass familiar that spills on the floor upon taking damage. After the milk spills, Isaac's tear delay is decreased by 2 for the current room.	1
Mom's Pearls	5.100.355		Range + luck up	+1.25 range, +0.5 tear height, +1 luck. Grants one Soul Heart.	2
More Options	5.100.414		There's options	Two items spawn in every Treasure Room. Only one can be taken; the other will disappear.	3
Mr. Dolly	5.100.370		Range + tears up	+0.7 tears, +5.25 range, +0.5 tear height, spawns 3 random types of Hearts on the floor when picked up.	3
Multidimensional Baby	5.100.431		ydduB Buddy	Spawns a familiar that will follow Isaac's movements on a 2.5-second delay. Tears that pass through the baby will be doubled and increase in speed.	1
My Shadow	5.100.433		Me! And my shaaaadow!	Each time Isaac takes damage, inflicts fear on all enemies in the room and spawns a black friendly Charger that will attack enemies. The Charger will be killed if it is damaged too much.	0
Night Light	5.100.425		Scared of the dark?	A cone of light shines in the direction Isaac is moving that slows enemies and enemy shots.	2
No. 2	5.100.378		Uh oh...	Continuously firing tears for three seconds causes Isaac to drop a Butt Bomb, which damages and confuses all enemies in the room when it explodes.	2
Obsessed Fan	5.100.426		Follows my every move...	Spawns a familiar that follows Isaac's movements on a 3 second delay and deals contact damage to enemies.	0
Papa Fly	5.100.430		Turret follower	Spawns a familiar that follows Isaac's movements on a 3 second delay, firing tears at nearby enemies.	1
Pay to Play	5.100.380		Money talks	+5 coins. Turns doors that require a single key into doors which need a coin to enter instead.	2
PJs	5.100.428		You feel cozy	Grants 4 Soul Hearts and fully restores Isaac's health.	2
Pupula Duplex	5.100.379		Wide shot	Gives Isaac spectral tears and gives his tears a wide arc shape, increasing their size.	2
Purity	5.100.407		Aura stat boost	Boosts one of Isaac's stats depending on the color of the aura around him. The aura disappears upon taking damage and reappears with a random color upon entering a new room. Red boosts damage, blue boosts tears, yellow boosts speed, and orange boosts range.	2
Restock	5.100.376		Never ending stores!	Causes shops to instantly restock their items when they are bought. Granted by default for every character in Greed Mode.	3
Rune Bag	5.100.389		Rune generator	Spawns a familiar that drops a random rune every 5-6 rooms.	3
Sack Head	5.100.424		More sacks!	Coins, bombs, keys, cards, runes and batteries have a chance to become sacks.	3
Scatter Bombs	5.100.366		We put bombs in your bombs!	Adds 5 bombs. Isaac's bombs explode into 2-4 tiny bombs.	1
Seraphim	5.100.390		Sworn friend	Spawns an angel familiar which follows Isaac and fires homing tears which deal 10 damage and have 75% shot speed.	3
Serpent's Kiss	5.100.393		The kiss of death	Tears have a chance to apply a poison effect to enemies. Isaac poisons enemies on contact. Poisoned enemies have a chance to drop a black heart when killed.	4
Spear of Destiny	5.100.400		Your destiny	In addition to tears, Isaac holds a spear in front of him which deals contact damage equal to 2x his tear damage, and occasionally inflicts fear.	1
Spider Mod	5.100.403		Mod buddy!	Displays Isaac's tear damage and enemy health bars. Spawns a familiar that wanders around and inflicts random status effects on enemies it touches. Can spawn a Lil' Battery/Blue spider upon clearing a room.	1
Sticky Bombs	5.100.367		Egg sack bombs!	+5 bombs. Bombs stick to enemies and spawn 2-4 Blue Spiders if they kill an enemy.	1
Succubus	5.100.417		Damage booster	Spawns a flying familiar that bounces around the room with a black aura, dealing rapid damage to any enemies inside it. While standing in the aura, Isaac gains a 1.5x tear damage multiplier.	3
Sworn Protector	5.100.363		Protective friend	Spawns an orbital familiar which does 105 damage per second and attracts and blocks enemy shots. Upon blocking 10 shots in a room, it drops an Eternal Heart.	3
Tech X	5.100.395		Laser ring tears	Tears are replaced with laser rings that pierce through enemies and deal damage to enemies within them. Can be charged to increase the effectiveness of the ring.	4
The Wiz	5.100.358		Double wiz shot!	Tears simultaneously fire out of both eyes diagonally, similar to the effect of the R U a Wizard? pill. Isaac's tears also travel above all obstacles.	1
Toxic Shock	5.100.350		Mass poison	Upon entering a room, poisons all enemies, dealing double Isaac's tear damage. Killing enemies leaves a small, short-lasting pool of green creep on the ground.	3
Tractor Beam	5.100.397		Controlled tears	Increases tears, range, and shot speed. Isaac emits a beam from his face that his tears follow along.	2
Zodiac	5.100.392		The heavens will change you	Gives Isaac a random zodiac item effect that changes every floor.	1

Trinkets

29 new trinkets were added in the expansion.

Name	ID	Icon	Quote	Description
Black Feather	5.350.80		With darkness comes power	Increases Isaac's damage for possessing certain evil items.
Blasting Cap	5.350.73		Pop! Pop!	Exploding bombs have a chance to drop another Bomb pickup.
Blind Rage	5.350.81		Blind to damage	Increases invincibility time after getting hit.
Blister	5.350.77		Bounce back!	Increases knockback of tears.
Bob's Bladder	5.350.71		Creepy bombs	Leaves a pool of green creep under all bombs Isaac places, which damages enemies that walk over it.
Brown Cap	5.350.90		Fartoom!	Poop explodes upon being destroyed.
Child Leash	5.350.89		Keep your friends close...	Causes familiars to stay closer to each other.
Cracked Dice	5.350.67		You feel cursed... kinda.	Activates the effect of The D6, D8, D12, or D20 whenever Isaac takes damage.
Endless Nameless	5.350.79		I'm stuck in a loop...	Has a 25% chance of creating a duplicate of any pill, card, or rune Isaac uses.
Error	5.350.75		Effect not found?	Gives a random trinket effect each room.
Faded Polaroid	5.350.69		You feel faded	Occasionally causes Isaac to blend into the ground, which briefly confuses all enemies in the room.
Golden Horse Shoe	5.350.82		Feel lucky?	+15% chance for Treasure Rooms to have two items. Only one item can be taken.
Karma	5.350.85		Karma up	Donating to a donation machine has a chance to heal Isaac for a full red heart or spawn a beggar. Increases the chance that donating to a Donation Machine will increase Isaac's luck.
Lazy Worm	5.350.66		Pft	Increases range by 4 and decreases shot speed by .4.
Lil Larva	5.350.86		The poop is moving...	Spawns a Blue Fly from every pile of poop that Isaac destroys.
Louse	5.350.70		Itchy, tasty...	Occasionally spawns a Blue Spider.
Mom's Locket	5.350.87		You feel her love	Grants half a red heart each time a key is used. Converts half red heart pickups into full red hearts.
NO!	5.350.88		Never again!	Prevents active items from being generated, if possible.
Poker Chip	5.350.76		It's double down time!	Chests have a 50% chance of paying out with extra pickups and a 50% chance of paying out with nothing or enemies.
Rainbow Worm	5.350.64		Bleep Bloop Blop	Isaac's tears gain a worm effect that changes every 3 seconds.
Rib of Greed	5.350.84		Feels greedy	Prevents Greed and Super Greed from appearing in shops and secret rooms, and makes coin drops after clearing rooms more likely.
Safety Scissors	5.350.63		Fuse Cutter	Troll bombs turn into Bomb pickups before they explode. Mega troll bombs turn into 1+1 free bombs before they explode.
Second Hand	5.350.78		Extended stat effect time!	Increases the time that status effects stay on enemies.
Shiny Rock	5.350.62		It shines for its brothers	Tinted rocks and rocks with crawl spaces flash white upon entering the room and every 10 seconds afterward.
Store Key	5.350.83		Stores are open	Shops can be opened without using keys.
Stud Finder	5.350.74		The ground below feels hollow...	Increases the chance to find a Crawl Space.
Super Magnet	5.350.68		It Pulls	Pulls enemies and pickups towards Isaac.
Tape Worm	5.350.65		Floooooooooop!	Doubles Isaac's range and halves his tear height.
Watch Battery	5.350.72		Lil charge	Increased chance of batteries spawning. Has a chance to add an extra charge to Isaac's activated item upon completing a room.

Pickups

Hearts

Heart	Image	Worth	Additional Info	Unlocked By
Gold Heart			When a Gold Heart is lost, a few coins will be dropped around you.	Complete XXXXXXXXL (challenge #21)

Coins

Coin	Image	Worth	Additional Info	Unlocked By
Lucky Penny		1	Increases luck by 1 when picked up.	Donate 1 coin to the Greed Donation Machine
Sticky Nickel		5	Will flip upside-down when Isaac tries to collect it. Afterwards, it will get stuck on the ground, unable to be picked up unless blasted off the ground with an explosion.	Complete the Boss Rush as Keeper

Bombs

Bomb	Image	Worth	Additional Info	Unlocked By
Gold Bomb		∞	Will not add to the player's bomb count, but when picked up, it will give the player unlimited bombs for the duration of the current floor, even if the current number of bombs is 0.	Complete Blue Bomber (challenge #23)

Pills

ID	Pill	Effect
28	Percs!	Gives The Wafer effect while in the room. Unlocked by completing Challenge #24: PAY TO PLAY.
29	Addicted!	Makes Isaac take a full heart of damage from all sources for the current room. Unlocked by completing Challenge #24: PAY TO PLAY.
30	Re-Lax	For a short time, poop spawns wherever Isaac moves, like Explosive Diarrhea but with poop. A higher move speed means you can touch more tiles in the same time. A pun on laxatives. Unlocked by completing Challenge #25: Have a Heart.
31	???	Gives the Curse of the Maze effect for the remainder of the floor. The effect can stack with other curses. If no other curses are active for the floor, Curse of the Maze will appear under the level name when TAB is held. This effect cannot be negated by Black Candle. Unlocked by completing Challenge #25: Have a Heart.
32	One makes you larger	Increases Isaac's size and decreases the pitch of his voice. This effect does not increase the size of Isaac's hitbox. These pills contribute to the Stompy transformation.
33	One makes you small	Decreases Isaac's size and increases the pitch of his voice. This effect decreases the size of Isaac's hitbox.
34	Infested!	Destroys all poop in the room and spawns a single Blue Spider under Isaac and on each destroyed poop.
35	Infested?	Spawns Blue Spiders equal to the number of enemies in the room. If there are no enemies in the room, spawns 1-3 Blue Spiders.
36	Power Pill!	Activates an effect similar to The Gamekid.
37	Retro Vision	Briefly pixelates the screen 3 times over 30 seconds.
38	Friends Till The End!	Spawns three blue flies.

Cards

Name	ID	Icon	Message	Description
Get out of Jail Free Card	5.300.47		Open Sesame	Upon use, opens all doors in the current room (including the golden door at The Chest / Dark Room), similar to Dad's Key.
? Card	5.300.48		Double active	When used, copies the effect of Isaac's currently held activated collectible.

Runes

Name	ID	Icon	Message	Description
Blank Rune	5.300.40		???	Grants a random rune effect excluding the Black Rune. Has a 25% chance to spawn another Blank Rune upon use.

Consumables

Name	ID	Icon	Message	Description
Dice Shard	5.300.49		D6 + D20	Upon use, activates the effects of The D6 and the D20 at the same time.
Emergency Contact	5.300.50		Help from above	When used, will cause two Mom's Hands to come down and grab two random enemies.

Chests

Eternal Chests

• Eternal Chests are similar in appearance to Gold Chests, except they glow bright blue instead of gold, like a soul heart. They require one key to unlock, but can be reopened a random amount of times, each time requiring another key. They can be found in Angel rooms, in I AM ERROR Rooms and rarely in a normal room. Their loot is similar to Golden Chests, but there is a 25% chance they will drop nothing upon opening. If they contain nothing or an item, they will no longer be able to be reopened.

Spiked Chests

• Spiked Chests are purple colored chests with spikes protruding from them that will deal damage to Isaac upon opening unless he has the Holy Mantle active, which nullifies the damage, or if found in The Chest/Dark Room, where they are free to open. They can be rarely found upon completing a room or in greed mode shops. Their loot is similar to Brown Chests. Unlike other chests, they do not appear on the minimap.

Sacks

Mystery sack

• Spawns 1-4 random pickups upon touching it. It will not drop any hearts, pills or chests, and they have an increased chance to drop batteries.

Entities

Monsters

Entity	ID	Description
Flaming Gaper	10.2	Walks towards Isaac, dealing contact damage. Usually turns into a Pacer or a Pacer#Gusher upon death.
Drowned Hive	22.1	Wanders around the room, avoiding Isaac and spawning Drowned Chargers if he gets close. Spawns 0-2 Drowned Chargers upon death.
My Shadow	23.0.1	Charges at enemies when in its line of sight, dealing contact damage. Will always spawn friendly via My Shadow.
Drowned Charger	23.1	Slowly moves around the room, charging at Isaac when he gets in its line of sight. Explodes into four blood shots in the ordinal directions upon death.
Dank Globin	24.2	Chases Isaac, dealing a full heart of contact damage. Upon taking enough damage, it collapses into a pile of goo, spawns a Spider, and leaves a puddle of slowing Black Creep. Will regenerate after a short time if not killed quickly. Leaves another puddle of Black Creep upon death.
Drowned Boom Fly	25.2	Flies around the room diagonally, dealing contact damage. Upon death, explodes and fires four blood shots in the cardinal directions. Also has a chance to spawn a Drowned Charger upon death.
Scarred Double Vis	39.3	Randomly wanders around the room. Pauses to charge and fire a Brimstone laser which fires from all four cardinal sides when Isaac gets in its line of sight.
Scarred Guts	40.1	Attaches itself to a wall or obstacle and rolls around it, leaving a trail of damaging Red Creep.
Scarred Para-Bite	58.1	Moves towards Isaac, dealing contact damage and firing a short-range blood shot at him. Can burrow underground and reappear elsewhere.
Flaming Fatty	208.1	Slowly walks towards Isaac. Occasionally farts, which pushes Isaac and adjacent enemies away. Has a chance to leave behind a damaging flame upon death.
Dank Death's Head	212.1	Moves diagonally around the room, dealing contact damage. Needs to be killed to complete the room.
Corn	217.1	Quickly dashes in random directions, dealing contact damage.
Brownie Corn	217.2	Quickly dashes in random directions, dealing contact damage.
Dank Squirt	220.1	Dashes towards Isaac and deals contact damage, creating slowing black creep. Spawns 2 Clots upon death.
Rag Man's Ragling	246.1	Quickly leaps towards Isaac and deals contact damage. Randomly shoots two purple shots that orbit around it.
Dart Fly	256.0	Flies towards Isaac and attempts to mimic his movements. Deals contact damage.
Conjoined Fatty	257.0	Slowly walks towards Isaac. Occasionally pauses to fart out a line of damaging Green Creep towards Isaac. Chance to turn into a regular Fatty upon death.
Blue Conjoined Fatty	257.1	Slowly walks towards Isaac and occasionally farts out a homing Ipecac shot at Isaac.
Fat Bat	258.0	Slowly flies towards Isaac. Tries to align itself diagonally to Isaac and shoots at him when in that alignment.
Imp	259.0	Slowly drifts towards Isaac, frequently firing 5 blood shots in quick succession towards him. Tries to avoid Isaac's shots and occasionally teleports and reappears elsewhere.
Roundy	276.0	Pops out of the ground in random locations, creating a small rock wave. Fires an explosive Ipecac shot at Isaac if he is in sight.
Black Bony	277.0	Wanders around the room and throws three bones in a row at Isaac when he is in sight. Explodes upon death.
Black Globin	278.0	Chases Isaac, dealing a full heart of contact damage and spawning Spiders whenever it takes damage. Spawns a Spider, a Black Globin's Head, and a Black Globin's Body upon death.
Black Globin's Head	279.0	Slides towards Isaac, leaving a trail of damaging Red Creep.
Black Globin's Body	280.0	Walks aimlessly around the room, occasionally spawning spiders.
Swarm Fly	281.0	Follows Isaac in large, tightly-clustered groups and deals contact damage.
Mega Clotty	282.0	Slowly moves around the room, occasionally hopping and either firing 6 blood shots in all directions, leaving a puddle of Red Creep, or spawning a Clotty or a collapsed Globin. Splits into two Clotties upon death.
Bone Knight	283.0	Moves erratically around the room, charges toward Isaac when in line of sight, and leaves behind a short-lasting trail of damaging Red Creep. Can only be damaged from behind.
Cyclopia	284.0	Walks towards Isaac, dealing contact damage and leaving behind a short-lasting trail of damaging Red Creep. Occasionally shoots a blood shot towards Isaac.
Red Ghost	285.0	Disappears, then reappears near Isaac and fires a brimstone laser.
Flesh Death's Head	286.0	Moves diagonally around the room, dealing contact damage. Releases 6 blood shots in all directions upon death. Can be killed, but also dies when the room is cleared.
Mom's Dead Hand	287.0	Falls from the ceiling. Upon landing, it spawns several rock waves that travel outwards. Spawns several spiders upon death. Entering a room containing Mom's Dead Hand will warn the player with Mom's laugh.
Dukie	288.0	Flies around the room diagonally, occasionally spitting out 1-2 Dart Flies.
Ulcer	289.0	Pops out of the ground in random locations and spawns a Dart Fly if Isaac is in sight. Fires a blood shot after spawning 6 Dart Flies.
Meatball	290.0	Slides around the room. If Isaac is in sight, it will stop to spew a fountain of short-range blood shots in all directions or to spit a line of damaging Red Creep towards Isaac. Spawns a Host upon death.
Pitfall	291.0	Invulnerable and stationary enemy which Isaac falls into when walked over, taking damage and popping back out after a short delay.
Teleport Pitfall	291.1	Invulnerable and stationary enemy which Isaac falls into when walked over, taking damage and popping back out at a random location after a short delay.
Suction Pitfall	291.2	Invulnerable and stationary enemy which sucks Isaac towards itself. Isaac falls into it when walked over, taking damage and popping back out after a short delay.
Ultra Greed Coin (Spinner)	293.0	Spins around the room, dealing contact damage.
Ultra Greed Coin (Key)	293.1	Spins on itself and opens a golden door around the room if not destroyed, spawning hordes of Greed Gapers.
Ultra Greed Coin (Bomb)	293.2	Spins on itself and explodes with a large radius if not destroyed.
Ultra Greed Coin (Heart)	293.3	Spins on itself and heals Ultra Greed for 13.125 HP each if not destroyed.
Corn Mine	295.0	Goes off when destroyed or after some time, then releases a cloud of poisonous gas and fires corny shots in eight directions.
Hush Fly	296.0	Gathers with other Hush Flies to form certain patterns. If spawned by Hush, can chase Isaac or orbit Hush. Deals contact damage.
Blue Gaper	297.0	Walks towards Isaac, dealing contact damage.
Blue Boil	298.0	Stationary enemy that decreases in size when hit, but regenerates to its full size until fully destroyed. Fires 1-3 blood shots towards Isaac when fully swollen.
Greed Gaper	299.0	Walks towards Isaac, dealing contact damage.
Dark Ball	404.1	Floats towards Isaac, doing contact damage.

Bosses

Rag Man	Little Horn	Dangle	Turdlings

The Frail	The Stain	The Forsaken	Brownie

Hush	Ultra Greed

Beggars

Bomb bum

Bomb Bums are extremely rare, and ask for bombs. Each bomb donated has a chance to have him drop 1-2 bomb pickups or an item from the Bomb Bum Item Pool. After spawning a pedestal item, the Bomb Bum will disappear and can no longer be donated to.

Environment

Chapters

Burning Basement	Flooded Caves
Dank Depths	Scarred Womb
??? (Blue Womb)

Challenges

Name	Conditions	Goal	Unlocked by	Unlocks
21. XXXXXXXXL	: yes : yes Every floor is the size of an XL Womb floor, but does not combine the floors of each chapter.		Defeat Mom	Gold Heart
22. SPEED!	: yes : yes Everything is sped up like the Broken Watch effect.		Defeat Mom	Get out of Jail Free Card
23. Blue Bomber	Blindfolded Starts with: Brother Bobby Kamikaze! Pyromaniac Mr. Mega : no : yes		Destroy 10 Tinted Rocks and defeat Mom's Heart 11 times	Gold Bomb
24. PAY TO PLAY	Starts with: Money = Power Sack of Pennies 50 coins : no : yes Every door costs 1 cent to enter. Isaac drops money when hit. Isaac dies if he run out of money.		Defeat Isaac as Cain	2 new pills
25. Have a Heart	Starts with: Charm of the Vampire : yes : yes Pennies drop instead of Red Hearts. Many items that restore Red Hearts have no effect.		Defeat Mom	2 new pills
26. I RULE!	Starts with: The Boomerang Key Piece 1 Key Piece 2 The Ladder Mom's Knife Trinity Shield : no : yes		Defeat ??? or The Lamb, and defeat Satan as Isaac Defeat Mega Satan	Poker Chip
27. BRAINS!	Blindfolded Starts with: 3 Bob's Brain Thunder Thighs : no : yes		Defeat Isaac 5 times	Stud Finder
28. PRIDE DAY!	Starts with: 3 Dollar Bill Rainbow Baby Rainbow Worm : no : yes Cannot drop or replace Rainbow Worm.		Defeat Mom	D8
29. Onan's Streak	Starts with: The Book of Belial Chocolate Milk : yes : yes Missing a shot deals damage to Judas.		Defeat Mom	Kidney Stone
30. The Guardian	Blindfolded Starts with: Holy Grail Isaac's Heart Punching Bag Spear of Destiny : no : yes Isaac's Heart will follow Punching Bag instead of Isaac.		Defeat Mom	Blank Rune

Changes

Player

Characters

Azazel

• His mini-brimstone's range can be increased with range up items or pills.

The Lost

• He is unlocked by dying in a Sacrifice Room while holding Missing Poster.

Items

Activated Collectibles

Bob's Rotten Head

• The head deals 3 times Isaac's tear damage as poison over time instead of either 6 or 8 points.

The Book of Belial

• Increases the chance to open the Devil Room or Angel Room by 12.5% after killing a boss while holding it instead of guaranteeing it.

Book of Revelations

• Increases chance for a Devil/Angel Room Door to open by 17.5% instead of 35%.

Butter Bean

• Knocks back enemy shots.

Crack the Sky

• The beams have a high chance to directly target enemies.

D4

• Previously held items are removed from the pause menu.

The D6

• Reroll an item after defeating The Fallen no longer replace the Devil Room item he drops to a random item from the normal boss item pool.

D10

• Fly enemies are only rerolled into other fly enemies.
• Red flies can't be rerolled anymore (even though enemies can be rerolled into them).

Flush!

• Floods the whole room with water.
• Flushes all poop-related enemies and bosses away.
• The ladders are covered in water but the walls are not when used inside a crawl space.

Guppy's Paw

• Can no longer be used without red heart containers.

Head of Krampus

• Has a 50% chance to rotate all beams around the player 90 degrees, similar to Krampus' second Brimstone attack.

The Jar

• Sprite changed.

Monstro's Tooth

• Does not affect if Monstro is in the room the item is used in.

The Poop

• Knocks back enemy shots.

Scissors

• Its recharge time is 2 rooms instead of 6 rooms.

Undefined

• Dark Room can no longer be cleared repeatedly.

Passive Collectibles

20/20

• Sprite changed.

3 Dollar Bill

• The type of randomized tear changes every 2–3 seconds. The item appears to select two tear effects at once, perhaps staggering the times at which each of those effects changes.
• If a run is quit, and then continued, 3 Dollar Bill will keep tear effects for the current room.

Abel

• Shoots tears towards Isaac regardless of which direction Isaac is shooting.

Ball of Bandages

• Blocks enemy shots.

Bob's Brain

• Bob's Brain is fired directly from where it is located in the chain of familiars behind Isaac, making aiming it slightly more difficult.
• Each copy takes up its own spot on the familiar line, but only the first one launches out. Respawning brains may end up stacking on top of each other.

Bomb Bag

• Can drop a Golden Bomb.

Box

• Can drop a Golden Bomb.

Butt Bombs

• Heals Brownie, Dangle, and Dingle.

Cain's Other Eye

• Each tear deals Isaac's tear damage.

The Common Cold

• The poison hits twice, dealing a total of double Isaac's damage.

Dr. Fetus

• Each bomb deals 5 times the character's normal tear damage instead of 3, plus a flat 30 damage. The flat 30 is not affected by damage multipliers.

Fire Mind

• Isaac gives a wide glow lighting up dark areas, such as those under the effects of the Curse of Darkness or the Dark One's attacks.

Isaac's Heart

• Brimstone shots damage the heart.

Leo

• Nullifies effects of One Makes You Small pills, One Makes You Larger pills, and other items that decrease the size of Isaac, such as Caffeine Pill.

Lost Contact

• Gives a shield to familiar's tears.

Lord of the Pit

• Speed boost is applied immediately.

Mom's Contacts

• Range and tears height buffs are applied immediately.

Mom's Knife

• If picked up twice in the same run, two knives are fired at once.

Punching Bag

• Dies after taking too much damage and then respawns after a long time. Exiting and continuing the run will cause it to reappear right away.
• Dies instantly by enemies' beam-type attacks, such as Uriel's and Gabriel's beam. This also includes enemies' Technology lasers such as Eye and Camillo Jr..
• Reappears instantly each time a familiar or orbital item is picked up.

Scorpio

• The poison hits twice, dealing a total of double Isaac's damage.

Steam Sale

• Having multiple Steam Sales reduces all shop prices to 0 coins.
• Causes the Deals with the Devil not to convert the heart-type automatically.

Stop Watch

• The slow is only applied after the player is hit.

Strange Attractor

• Isaac's bombs are magnetically attracted to the player character's tears.

Tech.5

• The laser can have the effect of Mysterious Liquid or Rubber Cement.

The Virus

• Each poison hit deals damage equal to Isaac's tear damage instead of 4 or 6 damage.
• Enemies killed after they have been inflicted with this type of poison have a 20% chance to drop Black Hearts.

Trinkets

Match Stick

• Can replace the Tick.

Missing Poster

• No longer displays a particular puzzle piece on the last will screen if Isaac dies in a Sacrifice Room while holding it.
• Dying in a Sacrifice Room while holding it unlock The Lost, regardless of the current character.
  • If The Lost was already unlocked, Isaac will be revived as The Lost and Missing Poster will be consumed.
  • If the player's character is already The Lost, he will be revived in the previous room and Missing Poster will be consumed.

Mysterious Paper

• Small chance to revive Isaac as The Lost upon death, like Missing Poster.

Tick

• Can be replaced by Match Stick.

Interactions

20/20 + Brimstone - Two brimstone shots are fired, without an increase in charge time. 20/20 + Epic Fetus - Makes two missiles drop one after the other. 20/20 + The Inner Eye - 5 shots are fired with the normal decrease in fire rate instead of 3. 20/20 + Mom's Knife - Two knives are now thrown instead of one. 20/20 + Mutant Spider - 6 shots are fired with the normal decrease in fire rate. 20/20 + Technology - Two technology shots are fired simultaneously. Azazel + Monstro's Lung - Gives several additional Brimstone beams around Azazel. Azazel + My Reflection - Greatly increases the Brimstone laser's range and makes the laser curve as Azazel moves around the room. Azazel + Technology - Technology laser wraps around the Brimstone beam, dealing extra damage, but not increasing Brimstone range. BBF + Brimstone - BBF will fire Brimstone beams in all directions upon exploding. Brimstone + Dr. Fetus - Isaac continuously fires bombs while charging the Brimstone beams. Brimstone + Epic Fetus - Fires 10 Brimstone beams in all directions upon impact of a missile. Brimstone + Monstro's Lung - 3-5 additional Brimstone beams fire in random directions. One beam always fire straight forward as normal. Brimstone + My Reflection - Makes the beam curve when moving. Brimstone + Mysterious Liquid - When Brimstone hits enemies or walls it leaves creep based on how long it hits. Brimstone + Proptosis - Doubles damage but it rapidly decreases with distance, down to 0.1 from about 6 tiles away. Brimstone + Rubber Cement - Brimstone beam bounces off walls, creating a second beam that does half damage. Azazel's Brimstone will continue to full length after bouncing but will deal half of the damage. Brimstone + Sad Bombs - Bombs explode into Brimstone beams in all directions. Brimstone + Tech.5 - Tech.5 fires at player's tear rate while Brimstone laser is charging. Brimstone + Technology - The Technology laser coils around the Brimstone beam, granting a 1.5x damage multiplier. Brimstone + Technology 2 - Laser fires while Brimstone is charging. Brimstone + Tough Love - Occasionally fires Brimstone beam with damage multiplier of Tough Love. Broken Watch + Stop Watch - Both the slow effect and the rarer speed up can trigger at the start of a room. However, getting hit in a sped-up room will trigger Stop Watch's slow down. Cricket's Body + Dr. Fetus - Bombs split outwards into 4 tiny bombs that are not affected by Isaac's bomb modifiers, which detonate almost immediately. Death's Touch + Fire Mind - Scythes now properly explode. Dr. Fetus + Hot Bombs - Bombs leave behind fire that damages enemies on contact after exploding. Dr. Fetus + Mom's Knife - Isaac continuously fires bombs while charging the knife. Dr. Fetus + Monstro's Lung - Shoots 6 bombs which need to be fully charged before firing. The bombs detonate simultaneously. Dr. Fetus + Mysterious Liquid - Exploding bombs leave behind a large pool of green creep. Dr. Fetus + The Parasite - Bombs split into two bombs upon exploding. Dr. Fetus + Poison tears - No damage increase from poison. Dr. Fetus + Polyphemus - Bombs become Mr. Mega bombs. After they explode, they leave behind a regular-sized bomb. Dr. Fetus + Sad Bombs - Fires tears as normally placed Sad Bombs would. If this synergy is combined with Ipecac, the tears from the bomb become explosive, which Isaac is not immune to. Tears fired from previous Dr. Fetus bombs can collide with other Dr. Fetus bombs (can be negated with spectral tears). Dr. Fetus + Spoon Bender - Bombs are purple and act as if Isaac had Bobby-Bomb. Dr. Fetus + Technology - Both bombs and lasers are fired. Dr. Fetus + Tough Love - Tears that would have fired a tooth shot instead become a bomb with the Mr. Mega, dealing more damage and shaking the screen. Epic Fetus + Hot Bombs - Creates a fire every time a shot lands. Epic Fetus + Ipecac + Sad Bombs - Tear Blast tears explode and can damage Isaac. Epic Fetus + Mom's Knife - Each explosion shoots 10 knives in a circle from the point of impact. Epic Fetus + Monstro's Lung - Adds 2 to 4 more crosshairs that orbit the main crosshair and fires a missile onto each crosshair. Epic Fetus + Mysterious Liquid - Exploding bombs leave behind a large pool of green creep. Epic Fetus + Sad Bombs - Missiles fire a burst of tears where they land. Epic Fetus + Spoon Bender - Cursor slides towards enemies. Epic Fetus + Strange Attractor - Enemies get drawn towards the crosshair. Epic Fetus + Spoon Bender - Cursor slides towards enemies Epic Fetus + Technology - Explosion shoots Technology lasers in all directions. When firing/moving the cursor, Isaaac still shoot his Technology laser. Epic Fetus + Technology 2 - Both the Technology 2 laser, and the Epic Fetus missiles will be active. Epic Fetus + Telepathy for Dummies - Cursor slides towards enemies. Fire Mind + Mysterious Liquid - When the Fire Mind tear explodes, a much larger pool of creep is left behind. Guppy + Ipecac - Ipecac shots now spawn blue flies on hit, both direct and indirect. Holy Mantle + Stop Watch - Blocking damage with Holy Mantle triggers the Stop Watch effect. The Inner Eye + Mutant Spider - Shoots 7 tears instead of 3. No further decrease in fire rate. Ipecac + Mysterious Liquid - Explosions leave behind a large pool of green creep. The Ludovico Technique + Mom's Knife + Technology - Creates an uncontrollable laser ring centered on Isaac. The knife becomes stuck under Isaac and cannot be fired. The Ludovico Technique + Monstro's Lung - Tear becomes a cluster of variably sized tears spread over a small area. The tears move at the same speed when controlled but constantly move around each other. The Ludovico Technique + Mysterious Liquid - Pools the size of the tear constantly form on the ground dealing large amounts of damage to any non-flying enemy inside the tear. A Lump of Coal + Brimstone - Beam will gradually increase in size and damage the farther it travels, on a multiplier that is roughly +20% per tile of distance. A Lump of Coal + Technology - Damage increases the further away the enemy is, on a multiplier that is roughly +20% per tile of distance. A Lump of Coal + Technology + Tiny Planet - The extra distance covered by the laser more than doubles damage right in front of Isaac, and it increases as normal further away. A Lump of Coal + Technology 2 - Damage increases the further away the enemy is, on a multiplier that is roughly +20% per tile of distance. Mom's Knife + Monstro's Lung - Fires a cluster of 3-5 knives at maximum charge, each dealing 2x damage. Mom's Knife + Technology - Both the knife and the laser fire normally. My Reflection + Technology - Makes the beam curve when moving. Has the same effect on Azazel's mini-brimstone and doubles the range. My Reflection + Technology 2 - Laser is bent as Isaac moves, then gradually becomes straight as he stands still. Mysterious Liquid + Technology - The laser spawns pools of liquid always when it hits obstacles and occasionally on enemies. Proptosis + Technology - The beam decreases in damage and width the farther it travels. Tears become virtually powerless across large rooms like the Boss Rush and the Hush fight. Proptosis + Technology 2 - The beam decreases in damage and width the farther it travels. Tears become virtually powerless across large rooms like the Boss Rush and the Hush fight. Pisces + Technology 2 - Laser can knock back enemies well due to its high fire rate. Rubber Cement + Technology - Laser bounces off of walls, creating a second beam that does half damage. Rubber Cement + Technology 2 - Laser bounces off of walls, creating a second beam that does half damage.

Pickups

Bombs

Troll Bomb

• Troll Bombs are now given a random amount of time before exploding. Before that, they always exploded at a fixed time. This means that if two Troll Bombs spawn at the exact time right next to each other, there's a high chance one Troll Bomb will blow up before the other, sending that Troll Bomb sliding outwards a bit before exploding.

Entities

Monsters

Bony

• Only leaves behind bones when killed.

Environment

Rooms

Boss Room

• Double Trouble boss rooms can now contain 2 bosses of different types. Additionally, they can appear as early as chapter 1.

Arcade

• Can contain a Bed, a Key Master and 3 hanging dead Shopkeepers.
• New layouts:

Angel Room

• Possible rewards found in the room include:
  • 2 Eternal Chests
  • 1 Eternal Heart, and 4 Soul Hearts behind Key Blocks
  • 6 coins
  • 2 Soul Hearts and 1 Gold Heart.
• Urns might spawn in the room.
• Killing Key Key Master and Shell Game Beggar no longer apply the 25% bonus.
• Donating to a Beggar until it pays out with an item on the current floor applies a 10% bonus instead of 25%.
• Donating to a Devil Beggar until it pays out with an item on the current floor applies a 10% bonus instead of 25%.
  • If this coin flip succeeds, a Devil Room will be generated regardless of the above coin flips.
• "You feel blessed!" fortune in the Sacrifice Room of the current floor applies a bonus:
  • If the "You feel blessed!" fortune appeared on the 3rd sacrifice, the chance will be 15%.
  • If the "You feel blessed!" fortune appeared on the 5th sacrifice, the chance will be 50%.
  • If both "You feel blessed!" fortunes appeared, the chance will be 65%.
• Angel Rooms that spawn after Isaac defeats Mom's Heart or It Lives will be normal Angel Rooms with items or pickups.
• A Troll Bomb can sometimes appear behind the Angel Statue, blowing it up. If the Angel fights have been unlocked, this will begin the boss fight if the player is not careful or quick enough to move the bomb.

Bedroom

• The clean bedroom occasionally has two clean beds instead of one.
• The trapdoor in a dirty bedroom has a chance to lead to a Crawl Space.
• Occasionally, one Rag Man will spawn inside the dirty bedroom.

Boss Rush

• There is a chance that there will only be 2 items to choose from. Additionally, items may be trapped behind rocks or spikes. Items may appear in the corners of the room instead of the center.
• All 15 waves are randomized. Each wave spawns two random bosses from the list. Each boss can only appear once per Boss Rush.
  • Brownie, Dangle, Dark One, Dingle, 3x Gurglings, Little Horn, Mega Fatty, Mega Maw, Polycephalus, Rag Man, The Adversary, The Cage, The Forsaken, The Frail, The Gate, The Haunt, The Stain, and 3x Turdlings can appear in the Boss Rush.
  • The angels Uriel and Gabriel can also appear.
• New layouts:

• If a sack spawns for whatever reason, picking it up will start the Boss Rush. The player can still pick up one of the pedestal items.

Black Market

• Black Market can no longer be accessed in The Chest and The Dark Room, and therefore cannot be used to collect more items.

Curse Room

• Can contain Reward Plates, cards, runes, Black Globin's Heads, Imps, and/or Nulls.

Challenge Room

• The three waves appear in random orders rather than the original orders.

Sacrifice Room

• The payouts only depend on the number of sacrifices made. The number of sacrifices is reset to 0 when the player goes to the next floor.
• Rewards are reworked:

№ of sacrifices on Current Floor	Chance	Reward
1st/2nd	50%	Nothing
	50%	1 Penny
3rd	33%	Nothing
	67%	"You feel blessed!" (increased chance to receive an Angel Room over a Devil Room for the current floor) Does not increase the chance of a Devil/Angel room after defeating a boss, only the chance of getting an Angel Room over a Devil Room. Can cause an Angel Room to spawn even if you already took a deal with the devil. Less of a modifier than the "You feel blessed!" effect below.
4th	50%	Nothing
	50%	1 random chest (The type of chest is governed by the same mechanic as room drops. Thus, brown chests are more likely to spawn than any other kind of chest.)
5th	33%	3 Pennies (These coins do not have a chance to spawn as a nickel or a dime.)
	67%	You feel blessed!" (Same conditions as 3rd sacrifice but a stronger modifier.)
6th	33%	Teleport to the Devil/Angel Room. (If the floor's Devil/Angel Room has not been entered yet, an Angel Room is guaranteed to spawn — even if you already took a Devil Deal.)
	67%	1 random chest (The type of chest is governed by the same mechanic as room drops. Thus, brown chests are more likely to spawn than any other kind of chest.)
7th	33%	1 random Angel Room pedestal item.
	67%	1 Soul Heart
8th	100%	6 Troll Bombs
9th	100%	Uriel battle
10th	50%	7 Soul Hearts
	50%	30 Pennies
11th	100%	Gabriel battle
12th and onwards	50%	Nothing
	50%	Teleport directly to the Dark Room

• Losing red hearts due to the spikes will reduce the chance for a Devil Room to appear.
• The amount of luck that the player has does not affect the payout probabilities.
• Angels are normally able to fly over spikes but will take damage from sacrifice room spikes.
• New layouts:

Secret Room

• Can contain 2 Reward Plates.

Shop

• There is a small chance when you bomb the Shopkeeper that they can turn into Greed and start attacking you.

Super Secret Room

• The Dark Room theme contains 4 Nulls and 6 pills or runes instead of 1 Black Heart.
• New themes:
  • Burning Basement: 2 Bomb Chests, a Shopkeeper, 3 TNT, and Fire Places, including Red Fire Places.
  • Flooded Caves: black poop and spikes.
  • Library: 1 Black Heart.
  • I AM ERROR: A Mom's Hand, random pickups, chests, cards, and trinkets.

Treasure Room

• There's a rare chance that a treasure room might contain two items to choose from, only one of which can be taken.
• Treasure rooms may also contain a Restock Machine, allowing Isaac to re-roll offered items if he has coins or bombs.
• New layouts:

Other

• When not having red hearts in Devil Room, the price of items switches to soul hearts.
• Krampus has a new attack pattern.
• The floor icons on the stage transition sprites are updated; instead of being large rectangles with the unknown ones being grey, the sprites feature a much thinner and more detailed border with the unknown floors being represented by a closed trap door.

Gallery

• 

  The title screen of The Binding of Isaac: Afterbirth.

Trivia

• Afterbirth is the placenta and fetal membranes discharged from the uterus after the birth of offspring, which might be why the title screen is bloody.