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

ID	Name	Description
2	Fun Guy	+1 Red Heart Container.
3	Seraphim	Grants flight and gives +3 Soul Hearts.
4	Bob	Isaac leaves a trail of green poisonous creep as he walks that deals 6 damage per second.
5	Spun	Gives +2 damage and +0.15 speed, and spawns a random pill upon transformation.
6	Yes Mother?	Isaac gains a stationary knife that trails directly behind him. It synergizes like Mom's Knife would.
7	Conjoined	Adds two tumors that fire diagonally from Isaac's head. -0.3 Damage, -0.3 Tears.
8	Leviathan	Grants flight and gives +2 Black Hearts.
9	Oh Crap	Whenever a pile of poop is destroyed, restores half of a red heart.
n/a	Super Bum	Replaces Bum Friend, Dark Bum, and Key Bum with Super Bum. This bum collects any of the other beggars' pickups, and offers twice the rewards.

Co-op

Special Babies

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

ID	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 by 2. Defeat Mega Satan as Samson to unlock it.
32	Cry Baby	Occasionally briefly increases Isaac's tears by 1. 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 by 2, shot speed by 0.5, and tear falling speed. 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. 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	Occasionally briefly gives Isaac the Paper Clip effect. 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	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 resembles Vectorman from the game Vectorman
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	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 and Metal Blocks in the current room into other random obstacles. Re-rolls most types of Obstacles in the current room into other random obstacles.	1
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 Hourglass	5.100.422	Turn back time	Rewinds time, putting Isaac back in the previous room and undoing anything that happened in the current room. Can only be used three times per floor, after which it functions like The Hourglass until the next floor.	3
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.	1
Mega Bean	5.100.351	Giga fart!	Petrifies all enemies in the current room for about 1.5 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	Isaac fires a giant laser for approximately 15 seconds. This laser deals massive damage, pushes Isaac backwards, and persists between rooms and floors.	4
Mine Crafter	5.100.427	Booom!	Places a Movable TNT barrel that can be pushed and used to destroy rocks or damage enemies. If used again in the same room while the previous TNT barrel is still intact, remotely detonates the TNT.	1
Mom's Box	5.100.439	What's inside?	Increases luck by 1 and doubles the effects of trinkets while held. When used, drops a random trinket on the ground.	2
Placebo	5.100.348	Pill mimic	Has the same effect as the Pill currently held by Isaac. The charge time is based on the power of the pill.	2
Tear Detonator	5.100.383	Remote tear detonation!	Splits all of Isaac's tears that are currently in the air into 6 tears that fire in all directions, which retain their damage and shot speed.	1
Teleport 2.0	5.100.419	I-Teleport!	Teleports Isaac to a room that has not been explored yet. Normal rooms are prioritized over special rooms, and common special rooms take priority over rarer ones.	3
Ventricle Razor	5.100.396	Short cutter	Creates up to two portals that remain even if Isaac leaves the room. Upon entering a portal, Isaac is teleported to the other portal.	1
Wooden Nickel	5.100.349	Flip a coin	Has a roughly 50% chance to drop a penny, nickel or dime, and a roughly 50% chance to do nothing.	1

Passive Collectibles

Name	ID	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 damaging black ring briefly appears around him. This ring can cause enemies to drop Black Hearts. After Isaac kills an enemy, adds a luck-based chance to spawn a damaging black ring around them.	3
Betrayal	5.100.391	Turn your enemy	Charms all enemies in the room when Isaac takes damage. Enemies are able to damage each other. If an enemy is damaged by another enemy, they will attack that enemy instead of Isaac.	1
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.	2
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. Heals 1 additional Red Heart.	2
Crown Of Light	5.100.415	The untainted gain power	+2 Soul Hearts. While Isaac has no empty red hearts, grants 2x damage, -0.3 shot speed, and increased range. 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.	0
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.	2
Evil Eye	5.100.410	Eye shot!	Adds a chance to fire a slow-moving eye that fires tears in the same direction as Isaac. The eye is destroyed when it hits an enemy or obstacle.	2
Explosivo	5.100.401	Sticky bomb shot!	Isaac's tears have a chance to stick to enemies and explode.	3
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.	1
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	Isaac is occasionally forced to stop firing and charge an attack that launches a massive piercing, spectral kidney stone and a barrage of tears. -0.2 speed, decreases range.	2
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.	2
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 a fly familiar that moves in a straight line and circles around the first wall or obstacle it hits. It deals 105 damage per second on contact. It deals 56 damage per second and forces nearby enemies to attack it.	2
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, increases range.	1
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.	3
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. After the milk spills, Isaac's fire rate is increased by 1 for the current room.	1
Mom's Pearls	5.100.355	Range + luck up	+1.25 range, +0.5 tear falling speed, +1 luck. +2.5 range, +1 luck. Grants one Soul Heart.	2
More Options	5.100.414	There's options	Two item pedestals are presented 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 falling speed, Spawns a combination of 3 Red Hearts, Soul Hearts or Black Hearts on the floor when picked up. +0.7 tears, +2.5 range, 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.	2
My Shadow	5.100.433	Me! And my shaaaadow!	Inflicts fear on all enemies in the room upon taking damage and spawns black friendly Chargers that attack enemies. Spawns a shadow familiar that closely follows behind Isaac. It spawns a black friendly Charger whenever an enemy touches it.	2
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.	1
Number Two	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 delay and deals 30 contact damage per second 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. Most doors require one Penny to open instead of a Key. +5 Coins. All locked doors, Locked Chests, and Key Blocks must be opened with one Penny instead of Keys.	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.	3
Restock	5.100.376	Never ending stores!	Causes Shops to instantly restock their items when they are bought. Outside of Greed Mode, the restocked item's cost is increased after each purchase.	2
Rune Bag	5.100.389	Rune generator	Spawns a familiar that drops a random rune after clearing enough rooms.	3
Sack Head	5.100.424	More sacks!	Spawns a Grab Bag on pickup. Coins, Bombs, Keys, cards, runes and batteries have a chance to become Grab Bags.	3
Scatter Bombs	5.100.366	We put bombs in your bombs!	+5 Bombs. Isaac's bombs explode into 2-4 tiny bombs.	1
Seraphim	5.100.390	Sworn friend	Spawns an angel familiar who 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.	2
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 2× his tear damage, and occasionally inflicts fear.	2
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. They also leave a long-lasting puddle of slowing white creep.	2
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 1.5× 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!	Grants spectral tears. Tears simultaneously fire out of both eyes diagonally, similar to the effect of the R U a Wizard? pill.	0
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	Isaac's tears are bound to a beam emitting in the direction he's firing. +0.5 Tears, +5.25 Range, +0.16 Shot Speed. +1 Fire Rate, +2.5 Range, +0.16 Shot Speed.	3
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	Quote	Description
Black Feather	5.350.80	With darkness comes power	Increases Isaac's Damage for each 'evil' item or trinket he possesses.
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!	Poops explode 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, D10, D12, or D20 (chosen randomly) 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. Can be used to open the Strange Door in The Depths.
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	Decreases shot speed by 0.5. Increases range 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 a Half Red Heart each time a Key is used. Converts Half Red Heart pickups into 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 replacing all of its contents with an Attack Fly.
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 Double 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 underneath 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 spawn a Crawl Space when a rock is destroyed.
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 falling speed. +3 range.
Watch Battery	5.350.72	Lil charge	Increased chance of Lil' 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 2 Coins 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, exactly like 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 Black Rune. Has a 25% chance to drop another Blank Rune on the ground upon use.

Consumables

Name	ID	Icon	Message	Description
Dice Shard	5.300.49		D6 + D20	Upon use, invokes the effects of The D6 and the D20 at the same time, re-rolling all item pedestals and pickups in the room.
Emergency Contact	5.300.50		Help from above	When used, will cause two Mom's Hands to come down and grab two random enemies, dealing damage and, if they have 40 or more HP, pinning them to the ground temporarily.

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
Gold Heart	5.10.7	{{{behavior}}}
Lucky Penny	5.20.5	{{{behavior}}}
Sticky Nickel	5.20.6	{{{behavior}}}
Golden Bomb	5.40.4	{{{behavior}}}
Spiked Chest	5.52	{{{behavior}}}
Eternal Chest	5.53	{{{behavior}}}
Grab Bag	5.69.1	{{{behavior}}}
Flaming Gaper	10.2	Walks towards Isaac, dealing contact damage. Usually turns into a Pacer or Gusher upon death.
Special Shopkeeper	17.3	{{{behavior}}}
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 across the room in straight diagonal lines, 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	208.2	Slowly walks towards Isaac. Occasionally farts, which pushes Isaac and adjacent enemies away and spawns a damaging flame. 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.
Black Poop	245.3	{{{behavior}}}
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 predict 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 launching Spiders towards Isaac 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	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 Isaac 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.
Suction Pitfall	291.1	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.
Teleport Pitfall	291.2	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.
Movable TNT	292.0	{{{behavior}}}
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

???

Challenges

Name

Conditions

Goal

Unlocked by

Unlocks

21. XXXXXXXXL

: 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

Everything is sped up like the effect. After the game timer reaches 16 minutes, Isaac starts taking damage every 10 seconds.

Defeat Mom

Get out of Jail Free Card

23. Blue Bomber

Blindfolded

Starts with:

: no

: yes

Destroy 10 Tinted Rocks and defeat Mom's Heart 11 times

Gold Bomb

24. PAY TO PLAY

Starts with:

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 and destroy 10 Tinted Rocks

2 new pills

25. Have a Heart

Starts with:

: 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:

: no

: yes

Defeat ??? or The Lamb, defeat Satan as

Isaac, and unlock

Defeat ??? or The Lamb, and defeat Satan as

Isaac

Defeat Mega Satan and unlock

Poker Chip

27. BRAINS!

Blindfolded

Starts with:
3

: no

: yes

Defeat Isaac 5 times

Stud Finder

28. PRIDE DAY!

Starts with:

: no

: yes

Cannot drop or replace .

Defeat Mom

D8

29. Onan's Streak

Starts with:

: yes

Missing a shot deals damage to

Judas.

Defeat

Mom

Unlock

Judas and

It Lives.

Kidney Stone

30. The Guardian

Blindfolded

Starts with:

: no

: yes

will follow 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 tear falling speed 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
1^st/2^nd	50%	Nothing
1^st/2^nd	50%	1 Penny
3^rd	33%	Nothing
3^rd	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.
4^th	50%	Nothing
4^th	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.)
5^th	33%	3 Pennies (These coins do not have a chance to spawn as a nickel or a dime.)
5^th	67%	You feel blessed!" (Same conditions as 3^rd sacrifice but a stronger modifier.)
6^th	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.)
6^th	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.)
7^th	33%	1 random Angel Room pedestal item.
7^th	67%	1 Soul Heart
8^th	100%	6 Troll Bombs
9^th	100%	Uriel battle
10^th	50%	7 Soul Hearts
10^th	50%	30 Pennies
11^th	100%	Gabriel battle
12^th and onwards	50%	Nothing
12^th and onwards	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.