The Binding of Isaac: Afterbirth †

Afterbirth † is an expansion to The Binding of Isaac: Afterbirth that was released on January 3, 2017 and costs $9.99.

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

Nicalis, the game's publisher, also created mod tools for easier creation of community mods with the release. They occasionally released updates to Afterbirth † that incorporated certain high-quality and popular mods. These updates are known as Booster Packs.

Features

• 111 new items, 38 new trinkets, and 22 new pickups.
• New final chapter with boss, new boss exclusive to Greedier Mode and 2 endings.
• 2 new playable characters.
• Greedier mode, the Hard mode equivalent to Greed Mode.
• 5 new challenges.
• 127 new achievements.
• 5 modding tools.
• 1500+ new rooms, including a few exceptionally rare ones.
• New victory lap feature.
• Bestiary that attempts to track the amount of times you have encountered, killed, and been killed by specific enemies.
• 4 new transformations.
• 5 content updates that feature fan-made mods added officially into the game, along with additional original content.
• 6 new bosses and new champion forms for existing bosses.
• 20 new enemies and 4 new champion forms.
• 2 new cutscenes and 4 music tracks.

Additions

Mechanics

HUD

Found HUD

• Found HUD is a HUD addition that appears on the left side of the screen that gives numerical values to the player's current stats (e.g., damage, luck, speed, devil room chance). It can be enabled through the options menu.
• It is based on the Missing HUD mod for Rebirth and Afterbirth.

Victory Lap

• A Victory Lap allows you to start a new run with almost all of your final items after completing the Dark Room. Multiple laps can be made as long as the Dark Room is cleared each time.
  • Completion Marks and most achievements cannot be earned.
  • Isaac will take a full heart of damage on all floors after beginning a victory lap (unless he has The Wafer).
  • Some items are lost upon starting a victory lap. Items lost this way are added back into their respective item pools and can be acquired again.
  • If the initial run was on normal difficulty, all victory laps will be on hard difficulty.
  • On the third and subsequent victory laps, the character will turn into The Lost. This version of The Lost does not get a Holy Mantle or D4. However, if the run was started as The Lost (or if the Holy Mantle was found) it is possible to keep the Holy Mantle from the previous run.
  • On the third and subsequent victory laps, Shops will no longer appear.
  • On the third and subsequent victory laps, Red Chests in the Dark Room will turn into Chests and Locked Chests.
  • Killing any final boss aside from The Lamb will end the game, and the run will not be continued further.

Menus

Options

Charge bars

• Added a new "charge bars" option in the menu, for passive items that need to be charged up before usage.
• This includes:
  • Brimstone (collectible and Azazel)
  • Chocolate Milk
  • Cursed Eye
  • Lil Brimstone
  • Lil Delirium
  • Lil Gurdy
  • Lil Monstro
  • Maw Of The Void
  • Mom's Knife
  • Monstro's Lung
  • Tech X
  • Bone Club (The Forgotten's throwable weapon)

RERUN

• RERUN is unlocked after completing the RERUN achievement.
• After winning a run the Continue option in the main menu will be replaced by Rerun. Selecting it starts a new run using most of the previous won run's items. Isaac will take full heart damage on all floors.

Player

Characters

Character	Apollyon	The Forgotten
		The Forgotten	The Soul
Health
Damage	3.5 (*1.00)	3.50 (*1.50)	3.50 (*1.00)
Tears	+0	+0, x1/2	+0
Shot speed	1	1	1
Range	23.75	23.75	23.75
Speed	1.0	1.00	1.30
Luck	0	0	0
Starting Pickups	None	None	None
Starting Item(s)	Void	Bone Club	Flight Spectral tears

Transformations

ID	Name	Appearance	Description
10	Bookworm		Roughly 25% of the time, Isaac shoots an extra tear, like 20/20.
11	Adult		+1 Red Heart container.
12	Spider Baby		Spawns a spider familiar that applies random status effects to enemies it comes in contact with.
13	Stompy		Taking damage has a chance to spawn rock waves. Isaac can break obstacles by walking over them.

Co-op

Special Babies

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

ID	Appearance	Name	Description
55		Mort Baby	Spawns a blue fly, and spawns a new blue fly whenever its blue fly is destroyed. Defeat Mega Satan as Apollyon to unlock it. The sprite greatly resembles Rotten Baby.
56		Apollyon Baby	Spawns with two Pretty Flies. Earn all Hard mode Completion Marks as Apollyon to unlock it.
57		Bone Baby	Wields a melee bone club instead of shooting tears, similarly to The Forgotten. Earn all Hard mode Completion Marks as The Forgotten to unlock it.
58		Bound Baby	Is bound to Isaac, similarly to The Forgotten's soul. Shoots spectral tears. Defeat Mega Satan as The Forgotten to unlock it.

Normal Babies

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

ID	Appearance	Name	Description
428		Magiccat Baby	A baby that resembles the avatar of Tikara, the artist of the Isaac Tarot deck.
429		Little Horn Baby	A baby that resembles Little Horn.
430		Folder Baby	A baby with a folder for a head.
431		Driver Baby	A baby that is driving a car.
432		Dragon Baby	A baby that resembles a dragon.
433		Downwell Baby	A baby that resembles the player character from Downwell.
434		Cylinder Baby	A baby that is shaped like a cylinder.
435		Cup Baby	A baby with a teacup for a head.
436		Cave Robot Baby	A baby that resembles Quote from Cave Story.
437		Breadmeat Hoodiebread Baby	A toothy baby with a slice of toast for a head that resembles Breadmeat, a member of the Isaac community.
438		Bigmouth Baby	A baby with a large, wide-open mouth.
439		Afro Rainbow Baby	A baby with a rainbow colored afro.
440		Afro Baby	A baby with an afro.
441		TV Baby	A baby with a television for a head.
442		Tooth Baby	A baby with a tooth for a head.
443		Tired Baby	A tired-looking baby.
444		Steroids Baby	A muscular baby.
445		Soap Monster Baby	A baby that resembles Balrog from Cave Story.
446		Rojen Whitefox Baby	A baby that resembles a white fox. (might be a reference?)
447		Rocket Baby	A baby that looks like a firework.
448		Nurf Baby	A baby that resembles D.Va from Overwatch.
449		Mutated Fish Baby	A baby that resembles Fish from Nuclear Throne.
450		Moth Baby	A baby that resembles Moth from Creepy Castle.
451		Buttface Baby	A baby with a butt for a face.
452		Flying Candle Baby	A baby that looks like a candle.
453		Graven Baby	A baby with long hair. (might be a reference?)
454		Gizzy Chargeshot Baby	A baby that resembles Gizzy from ChargeShot.
455		Green Koopa Baby	A baby that resembles a green koopa from Mario.
456		Handsome MrFrog Baby	A baby that resembles Handsome Mr. Frog from the game of the same name.
457		Pumpkin Guy Baby	A baby with a pumpkin for a head wearing a purple rag. Possible reference to Terraria's Pumpking.
458		Red Koopa Baby	A baby that resembles a red koopa from Mario.
459		Sad Bunny Baby	A baby that looks like a crying rabbit. This is a reference to the sprites creator, Mort Mort (MnrArt) and their character Sad Bunny Face.
460		Saturn Baby	A baby that resembles the main character from Sgt. Saturn.
461		Toast Boy Baby	A baby with a slice of bread for a head. This is a reference to the sprite's creator, Mort Mort (MnrArt) and their character Toast Boy.
462		Voxdog Baby	A baby that resembles Vox the Dog.
463		404 Baby	A baby that has the Error trinket for a head.
464		Arrowhead Baby	A baby with an arrow through its head.
465		Beanie Baby	A baby wearing a green beanie.
466		Blindcursed Baby	A baby with the Curse of the Blind's question mark for a head.
467		Burning Baby	A baby that's been burnt to a crisp.
468		Cursor Baby	A baby that looks like a mouse cursor.
469		Flybaby	A baby that looks like a fly.
470		Headphone Baby	A baby wearing headphones.
471		Knife Baby	A baby with a knife for a head.
472		Mufflerscarf Baby	A baby wearing a scarf.
473		Robbermask Baby	A baby wearing a stereotypical robber's ski mask.
474		Scoreboard Baby	A baby with a digital number display, like those at a sporting event or on an alarm clock, for a face.
475		So Many Eyes Baby	A baby with eyes all over its body.
476		Text Baby	A baby made out of text characters. (ASCII art)
477		Wing Baby	A baby with wings.
480		Imp Baby	A baby that resembles the modded character Fiend from Devil's Harvest MOD.
481		32bit Baby	A baby that resembles Isaac in a 32 bit style.
482		Adventure Baby	A baby that resembles Finn the Human from Adventure Time.
483		Bubbles Baby	A baby made entirely of tar.
484		Bulb Baby	A baby that's very bright for his age.
485		Cool Orange Baby	A baby that resembles a very cool orange with sunglasses.
486		Crazy Ghost Baby	A baby that resembles Crazy Diamond from JoJo's Bizarre Adventure. (Also possibly a reference to the modded character.)
487		Cursed Pillow Baby	A baby that's unfortunately pillow shaded.
488		Egg Baby	A baby that resembles the modded item Greg the Egg.
489		Factory Baby	A baby that resembles a strange cyborg.
490		Falling Baby	A baby that resembles William Foster from Falling Down.
491		Funny Baby	A baby that resembles Sans from Undertale.
492		Gamer Baby	A baby that resembles an epic gamer. Inspired by a prominent member of the Binding of Isaac community.
493		Glittery Peach Baby	A baby resembling an oddly British Baby Plum.
494		Pompadour Baby	A baby that resembles Josuke from JoJo's Bizarre Adventure. (Also possibly a reference to the modded character.)
495		Head Kick Baby	A baby that resembles the Facepunch Logo.
496		Horn Baby	A baby that resembles the modded character Chronos.
497		Ichor Baby	A baby that resembles Ichor beasts from the game Heckland.
498		Ill Baby	A baby that resembles the modded boss Mahalath.
499		Lazy Baby	A baby that resembles Garfield.
500		Mern Baby	Mern.
501		Necro Baby	A baby that resembles the Xenomorph from the Alien franchise.
502		Peeping Baby	A baby that resembles the modded boss The Peeping.
503		Penance Baby	A baby that resembles the modded character Sarah from Revelations.
504		Psychic Baby	A baby that resembles the modded character Mei.
505		Puppet Baby	A baby that resembles the costume for the modded item Pinhead from Happy Items Pack.
506		Reaper Baby	A baby that resembles the modded character Samael.
507		Road Kill Baby	A baby that got ran over.
508		Sausage Lover Baby	A baby that resembles _Kilburn, the lead developer for Antibirth.
509		Scribble Baby	A baby that resembles the modded character The Drawn.
510		Star Plant Baby	A baby that resembles the main character from Germination.
511		Twitchy Baby	A baby that resembles Twitch from Heckland.
512		Witch Baby	A baby that resembles the modded character Endor from Alphabirth.
513		Workshop Baby	A baby that references a common trope of workshop thumbnails when firing tears.
514		Hooligan Baby	A baby that resembles Čeda from LeatherIceCream's "Poor 4" animations.
515		Half Spider Baby	A baby that resembles Miroslav from LeatherIceCream's "Poor 4" animations.
516		Silly Baby	A baby that resembles Djole from LeatherIceCream's "Poor 4" animations.
517		Master Cook Baby	A baby that resembles Andre from LeatherIceCream's "Poor 4" animations.
518		Green Pepper Baby	A baby that resembles one of _Kilburn's characters.
519		Baggy Cap Baby	A baby that resembles one of _Kilburn's characters.
520		Stylish Baby	A baby resembling the character Ren from the currently unreleased game Shenanigans: World of Illusions.

Items

109 new items were added in the expansion: 29 activated items and 80 passive items.

Activated Collectibles

Name	ID	Icon	Quote	Description
Black Hole	5.100.512		Nothing can escape	Throws a black hole on the ground which sucks in and damages enemies and destroys nearby obstacles.
Book of the Dead	5.100.545		Rise from the grave	Creates a friendly Bony, Black Bony, or an orbital bone for each enemy killed in the current room. Creates a friendly Bony, Black Bony, Bone Fly, Revenant, Big Bony, or an orbital bone for each enemy killed in the current room.
Broken Shovel	5.100.550		It feels cursed	While held, causes Mom to continuously attempt to stomp on Isaac. Activating makes her stop for the current room or wave. One of two parts necessary to create Mom's Shovel.
Brown Nugget	5.100.504		Friendly fly	Spawns a stationary fly turret that lasts for the current room and fires tears at nearby enemies.
Clicker	5.100.482		Change	Transforms Isaac into another random character and removes the last item collected.
Compost	5.100.480		Gain more friends!	Doubles Isaac's Blue Flies and Blue Spiders, or spawns one if Isaac has none. Converts pickups in the current room into Blue Flies or Blue Spiders.
Coupon	5.100.521		Allow 6 weeks for delivery	While held, guarantees one item in every Shop will be on sale for half price. On use, makes a random item in the current room free.
Crooked Penny	5.100.485		50/50	Has a 50% chance to double all items, chests, trinkets, and pickups in the room. If the effect fails, spawns a Penny and the other items and pickups disappear.
D infinity	5.100.489		Reroll forever	Has the effect of a random die item that changes each use. Replicates the effect of almost any die item, and can be cycled through by pressing the drop key.
D1	5.100.476		What will it be?	Duplicates a random pickup in the room. The new pickup may be different than the original (i.e. a different card, etc).
Dataminer	5.100.481		109	Displaces enemy sprites for the current room and randomly increases one of Isaac's stats while decreasing another. Turns all items in the room into glitched items with random effects.
Delirious	5.100.510		Unleash the power!	Spawns Delirium as a random friendly boss that fights for Isaac. The boss lasts the for the current room. The boss persists between rooms. The charge time is based on the power of the boss summoned.
Dull Razor	5.100.486		I feel numb...	Hurts Isaac without depleting health, activating any items that trigger upon taking damage.
Eden's Soul	5.100.490		...	Spawns two random items from the current room's Item Pool and then disappears. Starts with no charges.
Mama Mega!	5.100.483		BOOOOOOOOOM!	Deals immense damage to all enemies, opens all bombable doors, and destroys all obstacles in the room. The effect occurs every time a new room is entered for the rest of the floor.
Metronome	5.100.488		Waggles a finger	Grants a random item effect for the current room.
Mom's Shovel	5.100.552		Lost but not forgotten	Creates a trapdoor that leads to the next floor. Unlocks The Forgotten when used on a mound of dirt that appears in Dark Room.
Moving Box	5.100.523		Pack and unpack	If the box is empty, picks up items and pickups in a room and stores them. If the box is not empty, places all stored items and pickups in the current room. Can carry up to 10 items or pickups at once.
Mr. ME!	5.100.527		Caaan do!	Summons a controllable ghost that can perform various tasks depending on what it targets.
Mystery Gift	5.100.515		Wrapped up nice for you!	Spawns a random item from the current room's item pool, with a chance to spawn A Lump of Coal or The Poop instead.
Pause	5.100.478		Stop!	Freezes all enemies until a fire button is pressed.
Plan C	5.100.475		My last resort	Kills all enemies in the room, then kills Isaac three seconds later.
Potato Peeler	5.100.487		A pound of flesh	Removes a Heart Container, increases damage and range, and grants a Cube of Meat.
Sacrificial Altar	5.100.536		He demands a sacrifice	Sacrifices up to two familiars and spawns an item pedestal for each familiar sacrificed. Converts all friendly spiders and flies into coins.
Sharp Straw	5.100.507		More blood!	Damages all enemies in the room. Has a chance to drop a Half Red Heart or Half Soul Heart if an enemy is hit. Damages all enemies in the room. Has a chance to drop a Half Red Heart if an enemy is hit.
Smelter	5.100.479		Trinket melter!	Consumes Isaac's currently held trinket and applies its effects permanently.
Sprinkler	5.100.516		Sprinkles.	Creates a stationary sprinkler for the current room that rotates and fires tears in 8 directions. The tears copy Isaac's stats and most tear effects.
Telekinesis	5.100.522		Power of the mind	Any enemy shots that come near Isaac for the next three seconds are held in place then fired back.
Void	5.100.477		Consume	Consumes all pedestal items in the room. Activated items will have their effects added to Void, and passive items will grant random stat upgrades.
Wait What?	5.100.484		I can't believe it's not butter bean!	Isaac farts, sending out a circular rock wave that destroys obstacles and hurts enemies.

Passive Collectibles

Name	ID	Icon	Quote	Description
7 Seals	5.100.526		Lil harbingers!	Spawns a random Harbinger familiar that changes every 10 seconds. Harbingers have different behaviors and spawn themed Locusts.
Acid Baby	5.100.491		Pills pills pills!	Spawns a familiar that drops a random pill every 3 rooms. Upon using a pill, all enemies in the room are poisoned.
Adrenaline	5.100.493		Panic = power	Increases damage based on how many empty Red Heart containers Isaac has.
Analog Stick	5.100.465		360 tears!	+0.35 tears up. Allows Isaac to fire tears diagonally.
Angelic Prism	5.100.528		Eclipsed by the moon	Spawns an orbital familiar with a large orbital radius. Tears that pass through the prism split into four multi-colored tears.
Angry Fly	5.100.511		He's violent	Spawns a fly familiar that orbits around a random enemy and deals 30 damage per second to enemies it comes in contact with.
Apple!	5.100.443		Trick or treat?	+0.3 tears. Adds a chance to fire a razor blade that deals 4× Isaac's damage.
Backstabber	5.100.506		Watch your back!	Isaac's tears deal double damage and inflict bleeding on enemies if they're facing away from Isaac.
Belly Button	5.100.458		What's in there?	Drops a random trinket. Grants a second trinket slot.
Big Chubby	5.100.473		Chub chub	Spawns a familiar that follows Isaac and charges across the room when Isaac fires, blocking shots and dealing 40.5 damage per second on contact.
Blanket	5.100.535		You feel Safe	Grants one Soul Heart. Upon entering a boss room, grants a shield that blocks one hit, then disappears.
Bloodshot Eye	5.100.509		Bloody friend	Spawns an orbital familiar that deals contact damage and fires a tear every 2 seconds. Spawns an orbital familiar that deals contact damage, blocks shots, and fires tears at enemies in its line of sight.
Bozo	5.100.513		Party time!	+0.1 flat damage, grants a Soul Heart. Enemies can randomly become briefly charmed or feared. Taking damage has a chance to spawn a Rainbow Poop.
Brittle Bones	5.100.549		Everything hurts	Replaces all Red Heart Containers with 6 empty Bone Hearts. Upon losing a Bone Heart, Isaac fires bones in 8 directions and permanently gains a tears up. Upon losing a Bone Heart, Isaac fires bones in 8 directions and permanently gains a fire rate up.
Broken Modem	5.100.514		Lag!	Enemies, enemy shots, tears, and pickups will briefly freeze in place at random intervals. The reward from clearing a room will sometimes be duplicated.
Broken Shovel	5.100.551		It feels cursed	One of two parts necessary to create Mom's Shovel. No effect if somehow obtained on its own.
Buddy in a Box	5.100.518		What could it be?!	Spawns a familiar with a random tear effect. The familiar is randomized at the start of each floor.
Camo Undies	5.100.497		Camo kid	Isaac becomes camouflaged at the beginning of each room. Until he shoots, all non-boss enemies will be confused. Isaac gains +0.5 Speed while camouflaged, and gains Tears and Damage upon breaking it.
Compound Fracture	5.100.453		Bone tears!	Increases Range. Tears turn into bones, which shatter into 1-3 bone shards upon hitting an enemy or obstacle.
Cone Head	5.100.457		Hard headed!	Grants a Soul Heart. Gives Isaac a chance to ignore any damage taken.
Contagion	5.100.466		Outbreak!	The first enemy killed in a room releases a gas cloud that poisons nearby enemies. Affected enemies will also release gas upon death, spreading the effect.
Dad's Lost Coin	5.100.455		I remember this...	+1.5 range, +1 tear falling speed. Drops a Lucky Penny. +2.5 range. Drops a Lucky Penny.
Dad's Ring	5.100.546		Father's blessing	Creates a ring of light around Isaac that petrifies enemies in contact.
Dark Prince's Crown	5.100.442		Loss is power	When at exactly one Red Heart, +0.75 tears, +1.5 range, and +0.2 shot speed. When at exactly one Red Heart, +2 fire rate, +1.5 range, and +0.2 shot speed.
Dead Tooth	5.100.446		Toxic breath	While firing, Isaac gains a green aura that poisons nearby enemies.
Death's List	5.100.530		Just hope you're not next...	Grants a pickup or stat upgrade if all enemies in a room are killed in the order they are marked.
Depression	5.100.469		:(	Spawns a familiar that leaves a trail of creep that damages enemies at 6 damage per second. Has a chance to spawn damaging beams of light onto enemies that touch the cloud.
Divorce Papers	5.100.547		Tears up + you feel empty	Grants one Bone Heart, +0.7 tears, spawns a Mysterious Paper.
Dog Tooth	5.100.445		Bark at the moon!	+0.3 damage, +0.1 speed. Plays a howl or bark sound when entering a room with undiscovered Secret Rooms or Crawl Spaces.
Duality	5.100.498		You feel very balanced	Whenever a Devil Room or Angel Room would spawn after defeating a boss, both rooms spawn. Only one can be entered.
Eucharist	5.100.499		Peace be with you	An Angel Room will always spawn after every boss fight, excluding the first floor and floors after Chapter 4.
Euthanasia	5.100.496		Needle shot	Adds a luck-based chance to fire needles that instantly kill basic enemies and deal triple damage to bosses. If a needle kills an enemy, it bursts into more tears/needles.
Eye of Belial	5.100.462		Possessed tears!	Grants piercing tears. After piercing one enemy, tears start homing and deal double damage.
Eye of Greed	5.100.450		Gold tears!	Every 20 tears, Isaac loses 1 Penny and shoots an additional gold tear that petrifies enemies and turns them into gold. Any enemy killed while in this state will drop coins.
Fast Bombs	5.100.517		Rapid bomb drops	+7 Bombs. Removes the delay between bomb placements, allowing them to be placed rapidly. Bombs will no longer knock each other away.
Finger!	5.100.467		Watch where you point that!	Spawns a finger familiar that faces in the same direction as Isaac, rapidly damaging enemies it points at for 10% of Isaac's damage.
Flat Stone	5.100.540		Skipping tears	Tears bounce off the floor, creating splashes. Splashes deal 25% of Isaac's tear damage to all enemies in a small area.
Ghost Pepper	5.100.495		Flame tears	Gives a chance to shoot fires alongside tears that block enemy shots and deal damage to enemies that touch them. Gives a chance to shoot blue fires alongside tears that become smaller as they travel.
Glaucoma	5.100.460		Blind tears!	Adds a chance to shoot tears that confuse enemies for an extremely long time.
Glyph of Balance	5.100.464		A gift from above	Grants 2 Soul Hearts and modifies drops from Champion monsters based on certain conditions. Also modifies room clear drops.
Greed's Gullet	5.100.501		Money = health!	Grants a Red Heart container for every 25 Coins Isaac has.
Haemolacria	5.100.531		I'm seeing red...	Turns Isaac's tears into large blood tears fired in an arc. Upon hitting the floor, an obstacle, or an enemy, they burst into many smaller tears in all directions. Increases tear delay.
Hallowed Ground	5.100.543		Portable sanctuary	Spawns a white poop familiar, which turns into a White Poop when Isaac is hurt. White poop has an aura that increases tear fire rate and can block enemy shots. The aura also increases damage by 20% and gives homing.
Hushy	5.100.470		Lil hush!	Spawns a Hush familiar that bounces diagonally around the room and deals contact damage. While firing tears, it stops moving. When stationary, Hushy will periodically fire out rings of projectiles.
Jacob's Ladder	5.100.494		Electric tears	Tears fire sparks of electricity in random directions upon hitting an obstacle or enemy.
Jaw Bone	5.100.548		Fetch!	Spawns a familiar that flies through the room while firing, dealing a flat 7 contact damage to enemies and retrieving pickups.
Jumper Cables	5.100.520		Bloody recharge	Grants an active item charge every 15 enemies killed.
King Baby	5.100.472		Hail to the king baby	Spawns a familiar that follows Isaac and makes other familiars follow it. While firing tears, other familiars stop moving.
Lachryphagy	5.100.532		Feed them!	Isaac's tears decelerate as they travel. Upon stopping or hitting an obstacle, they burst into 8 tears in all directions. Tears can be fired into other tears to feed them, increasing their damage.
Large Zit	5.100.502		Creep shots	Adds a chance to fire a creep shot that deals double damage and leaves a trail of slowing white creep.
Lead Pencil	5.100.444		He's a bleeder!	After every 15 tears fired, Isaac will fire a high-damage cluster of tears.
Leprosy	5.100.525		You're tearing me apart!	Taking damage grants a body part orbital that blocks shots and deals contact damage, up to a maximum of three. The body parts are destroyed after blocking enough damage.
Lil Delirium	5.100.519		Delirious friend	Grants a familiar that transforms into another random familiar every 10 seconds.
Lil Monstro	5.100.471		Ain't he cute?	Spawns a familiar that fires clusters of tears. Must be charged before shooting.
Lil Spewer	5.100.537		Puking buddy	Drops a random pill, and spawns a familiar that charges up and fires creep. Using pills changes the creep type.
Linger Bean	5.100.447		Crying makes me toot	Constantly shooting causes Isaac to release gas clouds that can be pushed by his tears and damage nearby enemies. The cloud will gradually increase in size, while the damage it does gradually decreases.
Little Horn	5.100.503		Big brother is watching	Adds a chance to fire a piercing tear that instantly kills any enemy that it touches. Adds a chance to fire a tear that summons Big Horn's hand to crush the first enemy it hits, instantly killing monsters or greatly damaging bosses.
Marbles	5.100.538		Choking hazard	Spawns 3 random trinkets. Taking damage has a 5% chance to swallow Isaac's currently held trinket, gaining its effect permanently.
Marrow	5.100.541		HP up?	Grants one Bone Heart and spawns three Red Hearts.
Metal Plate	5.100.449		It itches...	Grants one Soul Heart. Enemy shots have a chance to be reflected at the shooter as confusing tears.
Moldy Bread	5.100.456		HP up	Grants one full Red Heart container. Heals 1 additional Red Heart.
Mom's Razor	5.100.508		It's sharp!	Spawns an orbiting razor that deals contact damage and inflicts bleeding on enemies, causing them to slowly take damage over time.
Mystery Egg	5.100.539		Sacrificial insemination	Spawns an egg familiar, which hatches a random friendly monster when Isaac is hurt once per room. The power of the monster improves for each consecutive room cleared without taking damage.
Parasitoid	5.100.461		Egg tears!	Adds a chance to fire an egg sack which creates slowing creep and spawns 1-2 Blue Flies or Blue Spiders upon hitting an enemy.
Pointy Rib	5.100.544		Stabbing time	Spawns a bone familiar that hovers back and forth in front of Isaac, dealing damage equal to Isaac's damage.
Poke Go	5.100.505		Gotta catch em...	Upon entering a room with enemies in it, has a chance to spawn a random friendly enemy that persists across rooms.
Polydactyly	5.100.454		Hold me!	Allows Isaac to carry two cards, pills, or any combination of both. Spawns one random card, rune, or pill.
Pop!	5.100.529		Eyeball tears!	Replaces Isaac's tears with eyeballs that can bounce off of each other. The eyeballs are not limited by range, and will instead dissipate when they stop moving or when hitting an enemy or obstacle.
Sack of Sacks	5.100.500		Gives sacks	Spawns a familiar that drops a Grab Bag every few rooms cleared.
Schoolbag	5.100.534		Extra active item room	Allows Isaac to hold two active items.
Shade	5.100.468		It follows	Spawns a shadow familiar that follows Isaac's movements on a 1 second delay and deals contact damage to enemies. After dealing enough damage, it is absorbed by Isaac and spawns friendly Chargers.
Shard of Glass	5.100.448		Blood and guts!	Upon taking damage, Isaac has a chance to drop a full red heart, gain 5 range, and leave a trail of damaging red creep for the current room. Taking damage causes Isaac to bleed, spraying a volley of blood in the direction he fires. Bleeding will eventually damage him, but it can be stopped by picking up a Red Heart.
Sinus Infection	5.100.459		Booger tears!	Adds a chance to fire a booger that sticks to enemies and deals damage over time.
Slipped Rib	5.100.542		Projectile shield	Spawns a bone familiar that circles around Isaac and reflects enemy shots.
Sulfuric Acid	5.100.463		Acid tears!	+0.3 damage. Adds a chance to fire acidic tears which can destroy obstacles and open doors.
Tarot Cloth	5.100.451		I see the future	Drops a random tarot card. Doubles the effects of most cards and runes. Doubles the effects of tarot cards.
Technology Zero	5.100.524		Static tears!	Connects Isaac's tears with electricity that can damage enemies.
Trisagion	5.100.533		Smite thy enemy	Tears are replaced with piercing white blasts of light that deal less damage but can damage the same enemy multiple times.
Varicose Veins	5.100.452		I'm leaking...	Taking damage releases a ring of 10 high damage tears.
YO LISTEN!	5.100.492		Yo listen!	+1 luck. Spawns a fairy familiar that points out Secret Rooms, Crawl Space entrances, and tinted rocks.
Tonsil	5.100.474		Gross...	Grants a familiar that follows Isaac and blocks enemy shots.

Trinkets

38 new trinkets were added in the expansion.

Name	ID	Icon	Quote	Description
Baby-Bender	5.350.127		Feed them magic!	Grants Isaac's familiars homing shots.
Bag Lunch	5.350.105		I wonder what it is	Taking damage has a small chance to destroy the trinket and spawn Lunch.
Bat Wing	5.350.118		They are growing...	Upon killing an enemy, has a 5% chance to grant flight for the rest of the room.
Black Tooth	5.350.95		It looks dead	Adds a chance to fire a black tooth that deals double damage and poisons enemies.
Bloody Crown	5.350.111		Drips with blood...	Treasure Rooms appear in Chapter 4.
Butter!	5.350.122		Can't hold it!	Using an active item will drop it onto a pedestal on the ground. Taking damage may result in dropping an owned passive item.
Cracked Crown	5.350.92		Stat booster	Decreases Isaac's tear delay by 20%, and improves the effectiveness of his other stat upgrades by 33%. Improves the effectiveness of stat upgrades by 20%.
Crow Heart	5.350.107		Drain me	Red Heart damage will be taken before Soul Heart, Black Heart, and Rotten Heart damage.
Dim Bulb	5.350.101		I think it's broken	Provides a boost to all stats when Isaac's active item is completely uncharged.
Door Stop	5.350.124		Hold the door!	The last door Isaac went through stays open, allowing him to leave the room even if enemies are in it.
Duct Tape	5.350.109		Stuck!	Holds Isaac's familiars in place relative to his position.
Equality!	5.350.103		=	Turns pickups into their doubled versions while Isaac's numbers of coins, bombs, and keys are equal.
Extension Cord	5.350.125		Charged friends	Bolts of electricity arc between Isaac and his familiars, damaging any enemies between them.
Filigree Feather	5.350.123		Angelic spoils	Angels drop Angel Room items instead of key pieces when defeated.
Finger Bone	5.350.128		It looks brittle	Grants a chance to gain a Bone Heart upon taking damage.
Fish Tail	5.350.94		It also stinks!	Items and trinkets that generate Blue Flies or Locusts will generate twice as many.
Fragmented Card	5.350.102		Double moon	Makes two Secret Rooms spawn on each floor.
Hairpin	5.350.120		Danger charge	Fully recharges Isaac's active item upon entering a boss fight.
Locust of Conquest	5.350.117		I bring Conquest	Upon entering a room with enemies, spawns 1-4 White Locusts which damage enemies.
Locust of Death	5.350.116		I bring Death	Upon entering a room with enemies, spawns a Black Locust that does a very high amount of damage.
Locust of Famine	5.350.115		I bring Famine	Upon entering a room with enemies, spawns a Yellow Locust that damages and slows enemies.
Locust of Pestilence	5.350.114		I bring Pestilence	Upon entering a room with enemies, spawns a Green Locust which damages and poisons enemies.
Locust of War	5.350.113		I bring War	Upon entering a room with enemies for the first time, spawns a Red Locust which detonates upon impact with enemies.
Lost Cork	5.350.106		Uncorked	Increases the radius of any creep produced by Isaac.
Meconium	5.350.91		Eww	Black Poops can drop Black Hearts when destroyed. Poop has a chance to turn into Black Poop.
Nose Goblin	5.350.98		Seems magic...	Chance to fire a homing booger that sticks to enemies and deals damage over time.
Ouroboros Worm	5.350.96		Foop foop!	Tears travel in a large spiral pattern and gain spectral, with a small chance to gain homing. Also adds +0.4 Tears.
Pay to Win	5.350.112		...	Shop Restock Machines always spawn in Treasure Rooms.
Rotten Penny	5.350.126		Wealth of flies	Spawns a Blue Fly every time a coin is picked up.
Silver Dollar	5.350.110		Feels lucky...	Shops appear in Chapter 4.
Stem Cell	5.350.119		Regen!	Heals Isaac for a Half Red Heart upon traveling to the next floor. Heals 50% of Isaac's empty Red Heart containers upon traveling to the next floor.
Super Ball	5.350.99		Boing!	Makes tears have a chance to bounce off enemies and obstacles.
Tonsil	5.350.97		Sick...	When hit, there is a small chance to spawn a permanent tonsil familiar that blocks enemy shots. This can happen twice, after which the trinket is destroyed.
Used Diaper	5.350.93		You stink	Grants the Skatole effect in some rooms.
Vibrant Bulb	5.350.100		It needs power	Provides a boost to all stats when Isaac's active item is fully charged.
Walnut	5.350.108		That's a hard nut to crack!	Being hit by explosions will eventually destroy the trinket and spawn various pickups.
Wish Bone	5.350.104		Make a wish	Taking damage has a small chance to destroy the trinket and spawn a random item.
Wooden Cross	5.350.121		My faith protects me	Grants a shield that negates the first damage taken once per floor.

Pickups

Hearts

Heart	ID	Image	Worth	Additional Info	Unlocked By
Scared Heart	9			Identical to the standard Red Heart, but will run away as the player moves towards it. Heals with Maggy's Bow. Humbleing Bundle and Equality! will not double this.
Half Soul Heart	8				Reset 7 times in a row Switch PS4 Get a minus 10-win streak
Blended Heart	10		//	Fills up a full red Heart Container, but will act as a Soul Heart when no Containers are free. If Isaac is only missing half a Red Heart, it will fill that half, and give him half a soul heart as well. Dark Bum and The Jar will not collect this.
Bone Heart	11			Takes three hits to deplete and can be refilled with red hearts, but disappears permanently upon depleting.	It's complicated

Keys

Key	ID	Image	Worth	Additional Info	Unlocked By
Charged Key	4		1	Fully charges your currently held active item upon pickup. Key Bum will pick this up, but will not give Isaac any active charge.	Complete Pokey Mans (challenge #33)

Pills

ID	Pill	Effect
39	X-Lax	Creates a pool of slippery brown creep underneath Isaac.
40	Something's wrong...	Creates a pool of black creep beneath Isaac.
41	I'm Drowsy...	Upon use, slows all enemies for the duration of the room.
42	I'm Excited!!!	Upon use, increases the speed of all enemies for the duration of the room. The effect triggers again 30 seconds after use and 60 seconds after use.
43	Gulp!	Upon use, any trinkets that the player is holding are destroyed, and their effects are permanently applied to the player. Unlocked by acquiring the Once More With Feeling! achievement.
44	Horf!	Upon use, Isaac shoots an explosive tear with the Ipecac effect that always deals 200 damage. Unlocked by acquiring the Dedication achievement.
45	Feels like I'm walking on sunshine!	Temporarily makes Isaac invincible, similar to Unicorn Stump. Unlocked by acquiring the Sin Collector achievement.
46	Vurp!	Throws up the last pill you used. Will spawn itself if no other pills were taken beforehand. Unlocked by acquiring the U Broke It! achievement.

Cards

Name	ID	Icon	Message	Description
Ace of Clubs	5.300.27		Convert all	Turns all pickups, trinkets and chests in the room into Bombs. All non-boss enemies in the room are also transformed.
Ace of Diamonds	5.300.28		Convert all	Turns all pickups, trinkets and chests in the room into coins. All non-boss enemies in the room are also transformed into coins.
Ace of Spades	5.300.29		Convert all	Turns all pickups, trinkets and chests in the room into Keys. All non-boss enemies in the room are also transformed into keys.
Ace of Hearts	5.300.30		Convert all	Turns all pickups, trinkets and chests in the room into hearts. All non-boss enemies in the room are also transformed into hearts.
Holy Card	5.300.51		You feel protected	Grants a shield that blocks the next hostile damage that would be taken in the current room. Has a chance to spawn another Holy Card on use. Grants a shield that blocks the next hostile damage that would be taken.
Huge Growth	5.300.52		Become immense!	For the current room, makes Isaac larger, allows him to crush obstacles he walks on, and grants +7 flat Damage and +30 Range. For the current room, makes Isaac larger, allows him to crush obstacles he walks on, and grants +7 flat Damage and +3 Range.
Ancient Recall	5.300.53		Draw 3 cards	Spawns 3 random cards.
Era Walk	5.300.54		Savor the moment	For the current room, enemies are slowed, Isaac's speed is increased by 0.50, and his shot speed is decreased by 1.00.

Runes

Name	ID	Icon	Message	Description
Black Rune	5.300.41		Void	Deals 40 damage to all enemies in the room. Consumes all pickups in the room and turns them into Blue Flies and Spiders. Consumes all pedestal items in the room and turns them into random stat upgrades.

Chests

Mimic Chests

• Mimic Chests appear similar to Brown Chests until Isaac moves near, at which point they sprout spikes that damage the player as a Spike Chest would. They can be distinguished from Brown Chests by their darker, purplish-brown coloring, the grayish spot on each side of the latch where the spikes will sprout from and the bloodstain.

Entities

Monsters

Entity	ID	Description

Bosses

5 bosses were added in Afterbirth †. Additionally, Ultra Greed received a second form in Greed Mode's hard mode.

Rag Mega	Big Horn	Sisters Vis	The Matriarch

Delirium	Ultra Greedier

Environment

Chapters

The Void

Obstacles

Super special rock

• Super special rocks are tinted rock variants which are much harder to spot, as they have a smaller mark and are not discolored. Super special rocks takes two bombs to blow up, and drop the contents of two tinted rocks.

White poop

• White poop is surrounded by an aura that halves tear delay and has a high chance to block damage like the Cone Head item while Isaac stands within it. The aura disappears if the poop is destroyed.

Dirt Patch

• Dirt Patches are a small mound of dirt that can be dug into with certain items. Using Mom's Shovel on top of a Dirt Patch will reveal a skeleton and unlock The Forgotten. Once The Forgotten is unlocked, using Mom's Shovel, We Need To Go Deeper!, or Ehwaz on top of a Dirt Patch will dig up a random chest.

Machines

Mom's Dressing Table

• It appears in the starting room of a floor if Isaac has 8 or more items.
• If Isaac bumps into Mom's Dressing Table, his appearance will be randomly changed so that only a few of his items are displayed.
• Hitting Mom's Dressing Table with an explosive will cause it to vanish and drop 1-4 pills. There is a 1% chance to spawn one of the following items instead: Mom's Underwear, Mom's Heels, Mom's Lipstick, Mom's Bra, Mom's Pad, Mom's Eyeshadow, Mom's Contacts, Mom's Wig, Mom's Perfume or Mom's Pearls.

Achievements

Name	ID	Icon	Description	Unlock
1000000%	339		Just Stop!	Collect every item in the game, unlock all secrets and endings, and complete the Bestiary / Unlock 402 random achievements and have at least 510 items in the collection page
5 Nights at Mom's	323		Unlocked super special rocks.	Get a 5-win streak, using a different character each time ( this number can be reduced to 3, see the notes section)
7 Seals	372		Unlocked a new item.	Defeat all 5 Harbingers
Ancient Recall	362		Unlocked a new item.	Use Cards and Runes 20 times
Angelic Prism	373		Unlocked a new item.	Defeat an Angel 10 times
Angry Fly	352		Unlocked a new item.	Become Beelzebub
Apollyon	340		Unlocked a new character.	Defeat Mega Satan
Apollyon Baby	319		Unlocked a new co-player baby.	Earn all Hard mode Completion Marks as Apollyon
Aprils fool	278		Unlocked a new challenge.	Defeat Mom
Baby-Bender	389		Unlocked a new item.	Use I - The Magician or Telepathy For Dummies while already having homing tears
Backasswards	277		Unlocked a new challenge.	Defeat ??? or The Lamb Defeat Mega Satan and unlock The Negative
Bat Wing	304		Unlocked a new item.	Defeat Ultra Greedier as Azazel
Black Hole	349		Unlocked a new item.	Defeat 20 Portals
Black Rune	309		Unlocked a new item.	Defeat Ultra Greedier as Apollyon
Blanket	385		Unlocked a new item.	Sleep in 10 beds
Bloody Crown	287		Unlocked a new item.	Defeat Delirium as Samson
Bone Baby	402		Unlocked a new co-player baby.	Earn all Hard mode Completion Marks as The Forgotten
Bone Heart	391		Unlocked a new item.	It's complicated
Book of the Dead	401		Unlocked a new item.	Defeat Delirium as The Forgotten
Bound Baby	403		Unlocked a new co-player baby.	Defeat Mega Satan as The Forgotten
Bozo	353		Unlocked a new item.	Destroy 5 rainbow poops
Brittle Bones	396		Unlocked a new item.	Defeat The Lamb as The Forgotten
Broken Modem	354		Unlocked a new item.	Complete 7 Daily Challenges (by touching the trophy at the end)
Brown Nugget	316		Unlocked a new item.	Defeat Ultra Greed as Apollyon
Buddy in a Box	355		Unlocked a new item.	Pick up 5 familiars in a single run
Burning Basement	342		Alt stage to the basement.	Defeat Mom's Heart 11 times
Butter!	360		Unlocked a new item.	Complete 2 Victory Laps by defeating The Lamb
Charged Key	333		Unlocked a new item.	Complete Pokey Mans (challenge #33)
Compound Fracture	291		Unlocked a new item.	Defeat Delirium as Lazarus
Coupon	364		Unlocked a new item.	Purchase anything from Shops, Devil Rooms, and/or Black Markets 50 times
Crooked Penny	294		Unlocked a new item.	Defeat Delirium as Keeper
Crow Heart	302		Unlocked a new item.	Defeat Ultra Greedier as Eve
D infinity	282		Unlocked a new item.	Defeat Delirium as Isaac
D1	296		Unlocked a new item.	Defeat Ultra Greedier as Isaac
Dad's Lost Coin	307		Unlocked a new item.	Defeat Ultra Greedier as The Lost
Dad's Ring	400		Unlocked a new item.	Defeat Ultra Greedier as The Forgotten
Dank Depths	344		Alt stage to the depths.	Defeat It Lives! 21 times
Dark Prince's Crown	290		Unlocked a new item.	Defeat Delirium as Azazel
Death's List	376		Unlocked a new item.	Take 25 Deals with the Devil
Dedication	325		Unlocked a new item.	Participate in 31 Daily Challenges (they don't have to be consecutive; it will still count if Isaac dies in the first room)
Delirious	338		Unlocked a new item.	Defeat Delirium
Divorce Papers	397		Unlocked a new item.	Complete the Boss Rush as The Forgotten
Door Stop	375		Unlocked a new item.	Blow up doors and Secret Room walls 50 times
Duality	306		Unlocked a new item.	Defeat Ultra Greedier as Lilith
Dull Razor	288		Unlocked a new item.	Defeat Delirium as Eve
Eden's Soul	289		Unlocked a new item.	Defeat Delirium as Eden
Era Walk	363		Unlocked a new item.	Add both the Broken Watch and the Stop Watch to your collection
Eucharist	283		Unlocked a new item.	Defeat Delirium as Magdalene
Euthanasia	292		Unlocked a new item.	Defeat Delirium as Lilith
Extension Cord	381		Unlocked a new item.	Have The Battery, 9 Volt, and Car Battery in Isaac's collection
Eye of Belial	299		Unlocked a new item.	Defeat Ultra Greedier as Judas
Eye of Greed	308		Unlocked a new item.	Defeat Ultra Greedier as Keeper
Fast Bombs	356		Unlocked a new item.	Defeat Little Horn 20 times
Filigree Feather	370		Unlocked a new item.	Acquire both Key Piece 1 and Key Piece 2
Finger Bone	399		Unlocked a new item.	Defeat Ultra Greed as The Forgotten
Flat Stone	382		Unlocked a new item.	Acquire Rubber Cement 5 times
Flooded Caves	343		Alt stage to the caves.	Defeat It Lives! 16 times
Glyph of Balance	297		Unlocked a new item.	Defeat Ultra Greedier as Magdalene
Greed's Gullet	335		Unlocked a new item.	Complete Pong (challenge #35)
Greedier!	341		New mode unlocked!	Donate 500 Coins to the Greed Donation Machine
Haemolacria	377		Unlocked a new item.	Acquire Blood Clot 10 times
Hairpin	358		Unlocked a new item.	Recharge using Lil' Batteries 20 times
Hallowed Ground	398		Unlocked a new item.	Defeat Hush as The Forgotten
Hat trick!	322		Unlocked a new item.	Get a 3-win streak
Holy Card	293		Unlocked a new item.	Defeat Delirium as The Lost
Huge Growth	361		Unlocked a new item.	Be 3 times larger than the starting size. Depending on the item/card/pill size's multiplier, 5 to 7 size increases will be required.
Hushy	315		Unlocked a new item.	Defeat Hush as Apollyon
It's the Key	327		Unlocked a new item.	Defeat The Lamb without taking Hearts, Coins, or Bombs through the entire run. Letting certain familiars (e.g. Bum Friend, Dark Bum, Bumbo or Lil Portal) or bosses (e.g. Bumbino) pick up the consumables fails this condition as well
Jaw Bone	395		Unlocked a new item.	Defeat ??? as The Forgotten
Jumper Cables	367		Unlocked a new item.	Pick up any 2 of the following items in a single run: 9 Volt, The Battery, and Car Battery ( Any 2 items that have the 'battery' item tag)
King Baby	286		Unlocked a new co-player baby.	Defeat Delirium as ???
Lachryphagy	378		Unlocked a new item.	Collect 10 "Tears Up" items or pills in one run
Laz Bleeds More!	331		Unlocked a new starting item.	Complete Backasswards (challenge #31)
Leprosy	368		Unlocked a new item.	Beat Chapter 3 without taking damage
Lil Delirium	357		Unlocked a new item.	Defeat Delirium for the 1st time
Lil Spewer	384		Unlocked a new item.	Have Isaac die to his own explosion from Ipecac, Bob's Rotten Head, or a Horf! pill
Living on the edge	329		Unlocked a new item.	Complete a Chapter (floors I and II) after Basement, start-to-finish, with only half a Heart total (can use The Lost)
Locust of Conquest	314		Unlocked a new item.	Complete the Boss Rush as Apollyon
Locust of Death	313		Unlocked a new item.	Defeat The Lamb as Apollyon
Locust of Famine	312		Unlocked a new item.	Defeat ??? as Apollyon
Locust of Pestilence	311		Unlocked a new item.	Defeat Satan as Apollyon
Locust of Wrath	310		Unlocked a new item.	Defeat Isaac as Apollyon
Maggy Now Holds a Pill!	332		Unlocked a new starting item.	Complete Aprils Fool (challenge #32)
Marbles	386		Unlocked a new item.	Use 5 Gulp! pills in one run (Placebo uses count)
Marrow	392		Unlocked a new item.	Defeat Mom's Heart or It Lives! on Hard mode as The Forgotten
Meconium	300		Unlocked a new item.	Defeat Ultra Greedier as ???
Metronome	303		Unlocked a new item.	Defeat Ultra Greedier as Eden
Mort Baby	317		Unlocked a new co-player baby.	Defeat Mega Satan as Apollyon
Moving Box	366		Unlocked a new item.	Use Pandora's Box in Dark Room
Mr. ME!	371		Unlocked a new item.	Open 20 Locked Chests
Mr. Resetter!	328		Unlocked a new item.	Reset 7 times in a row Switch PS4 Get a minus 10-win streak
Mystery Egg	387		Unlocked a new item.	Spawn three charmed enemies in the same room
Mystery Gift	350		Unlocked a new item.	Destroy 500 rocks
New Area	320		Unlocked a new area.	Defeat Hush
Once More with Feeling!	321		Unlocked a new item.	Complete a Victory Lap by defeating The Lamb
Plan C	305		Unlocked a new item.	Defeat Ultra Greedier as Lazarus
Pointy Rib	394		Unlocked a new item.	Defeat Satan as The Forgotten
Pokey Mans	279		Unlocked a new challenge.	Defeat Mom's Heart 11 times
PONG	281		Unlocked a new challenge.	Defeat Isaac 5 times
Pop!	374		Unlocked a new item.	Beat Chapter 4 without taking damage
RERUN	337		Unlocked the power of RERUN.	Complete 3 Victory Laps by defeating The Lamb
Rotten Penny	388		Unlocked a new item.	Have 20 Blue Flies at the same time
Sack of Sacks	298		Unlocked a new item.	Defeat Ultra Greedier as Cain
Sacrificial Altar	383		Unlocked a new item.	Take 50 Deals with the Devil
Samson Feels Healthy!	334		Unlocked a new starting item.	Complete Ultra Hard (challenge #34)
Scarred Womb	345		Alt stage to the womb.	Defeat It Lives! 30 times
Schoolbag	379		Unlocked a new item.	Enter 6 Shops in one run
Shade	285		Unlocked a new item.	Defeat Delirium as Judas
Silver Dollar	284		Unlocked a new item.	Defeat Delirium as Cain
Sin collector	324		Unlocked a new item.	Collect every entry in the Bestiary (bugged v190 - Mobs that don't exist in the bestiary are being counted. This allows Sin Collector to be unlocked without a complete bestiary)
Slipped Rib	393		Unlocked a new item.	Defeat Isaac as The Forgotten
Smelter	318		Unlocked a new item.	Defeat Mom's Heart or It Lives! on Hard mode as Apollyon
Something wicked this way comes!	346		Unlocked new bosses!	Defeat ??? as 3 different Characters
Something wicked this way comes+!	347		Unlocked even more bosses!	Defeat ??? as 6 different Characters
Sprinkler	351		Unlocked a new item.	Beat Chapter 1 without taking damage
Stem Cell	301		Unlocked a new item.	Defeat Ultra Greedier as Samson
Technology Zero	369		Unlocked a new item.	Pick up any 2 technology items in a single run ( Any 2 items that have the 'tech' item tag)
Telekinesis	365		Unlocked a new item.	Beat Chapter 2 without taking damage
The Forgotten	390		Unlocked a new character.	It's complicated
The gate is open!	348		Unlocked new enemies!	Defeat The Lamb
The Marathon	336		Unlocked a new item.	Get a 5-win streak in the Daily Challenges (they don't have to be consecutive days, only the runs you play are counted)
Trisagion	380		Unlocked a new item.	Take 25 Angel Rooms items
U Broke It!	330		Unlocked a new item.	Obtain 50 items in a run (duplicate passive items/familiars count towards the total, e.g., multiple Breakfast)
Ultra Hard	280		Unlocked a new challenge.	Defeat ??? or The Lamb. Possession of The Polaroid / The Negative is required, barring getting to Dark Room through a Sacrifice Room. Defeat Mega Satan and unlock The Negative
Void	295		Unlocked a new item.	Defeat Delirium as Apollyon
Wooden Cross	359		Unlocked a new item.	Sleep in a bed
ZIP!	326		Unlocked a new item.	Defeat The Lamb in under 20 minutes

Changes

Menus

Collection page

• The navigation is faster and loops back on itself when scrolling vertically.

Loading screen

• Loading images are smoother.

Player

Characters

General

• Adjusted the stats of each character in the character selection menu to better reflect their actual in-game stats.
• Adjusted pickup animation so items no longer obstruct Isaac's face.
• Bloodstains on costumes are now consistently the same color.

Eden

• Holding R to reset will consume an Eden Token and start a new run.
• Added 30 hairstyles.
• Can be randomized if the player has Eden tokens.

Eve

• Starts with Razor Blade only if it has been unlocked.
• Leaves a pool of blood behind instead of pee when walking between rooms at low HP.

Lilith

• Starts with Cambion Conception only if it has been unlocked.

Transformations

Conjoined

• Its costume has color alts.

Seraphim

• Its costume has color alts.

Spun

• Its costume has color alts.

Yes Mother?

• Its costume has color alts.

Familiars

• Teleport to the player's new position if it was changed by a boss such as Gurdy or Mom's Heart.
• Most sources of Blue Spiders throw those spiders out instead of spawning them on the ground.
• Following familiars are no longer pushed back when very close to the player.

Co-op

• Co-op babies can no longer drop out while the player is playing a pickup animation.

Items

General

• Mushroom items play their unique pickup sound.

Activated Collectibles

General

• Some sprites changed:

Breath of Life

• Can be held down between rooms.
• Added some visual feedback when it provides its invincibility.

Butter Bean

• If Isaac swaps Butter Bean for a different active item, then picks up Butter Bean again, it has a small chance to transform into Wait What?.

D4

• Re-rolls each of Isaac's passive items into a random item from the specific item pool where it was acquired.

Diplopia

• No longer spawns extra items for empty item pedestals.

Flush!

• Poops spawned react to damage similarly to regular poops.

Friendly Ball

• Can catch Lil Haunts.

Glowing Hourglass

• Revert the player's character if it was changed by an item during the current room.
• Rewinds event counters (this includes donations and Eden's Blessings).
• Co-op babies are saved and restored.
• No longer duplicates Blue Flies, Blue Spiders and perma-charmed enemies.

Guppy's Head

• The number of flies is seeded.

Head of Krampus

• Lasers no longer have a chance to rotate.

The Jar

• Its sprite changes based on how many hearts it contains.

Jar of Flies

• Its sprite changes based on how many flies it contains.

Mine Crafter

• Spawns a TNT barrel directly at the player's position rather than on a nearby free tile.

My Little Unicorn

• Its costume has color alts.

Pandora's Box

• Adjusted the contents in Greed mode.

Satanic Bible

• Plays its use animation.

Shoop da Whoop!

• Damage halved to compensate.

Undefined

• The Void is reset on exiting the I AM ERROR room and can be cleared repeatedly as long as the player is able to gather enough charges to successfully warp to it.

Ventricle Razor

• Portals will now appear closed if they have no connected portal.
• Portals got a few minor visual tweaks.

Passive Collectibles

General

• Some sprites changed:

Ball of Bandages

• Decreased the damage rate of level 3 and 4 to match Cube of Meat.

The Battery

• Self-recharging active items can charge the yellow meter, allowing Isaac to use them twice immediately.

Betrayal

• No longer triggers if there are fewer than 2 enemies in the room.
• Its costume has color alts.

BFFS!

• Increases spawner familiar spawn rates.

Black Candle

• Makes the darkness from Curse of Darkness fade away instead of immediately lighting the room up.

The Body

• Its costume has color alts.

BOGO Bombs

• Its costume has color alts.

Bursting Sack

• Its costume has color alts.

Cancer

• Its costume has color alts.

Dead Eye

• The multiplier will no longer be lost when hitting poops or TNT barrels.

E. Coli

• Poops spawned react to damage similarly to regular poops.

Eden's Blessing

• Is now limited to a maximum of 10 to prevent potential crashes.

Epiphora

• Being hit, changing rooms, and using items no longer reset the Epiphora bonus.
  • During the delay when transitioning between rooms, picking up an item, or using an active item, it's possible to change firing direction without resetting the bonus.

Fate

• Its costume has color alts.

Fruit Cake

• New possible effects:
  • Compound Fracture
  • Euthanasia
  • Eye of Greed
  • Jacob's Ladder
  • Little Horn
  • Ouroboros Worm
  • Parasitoid
  • Sinus Infection
  • Sulfuric Acid

Gemini

• Added extra familiar animations.

Hive Mind

• The effect also applies to locusts.

Holy Grail

• Its costume has color alts.

Holy Mantle

• The shield is no longer restored if the player saves and continues after losing it.

Immaculate Conception

• Its costume has color alts.

Key Piece 1 / Key Piece 2

• Will drop from angels that are not in Angel Rooms.

Kidney Stone

• Causes Isaac to fire "tears" from the middle instead of from his eyes, and at a slightly lower height.

Lil Brimstone

• Got renamed from "Lil' Brimstone" to "Lil Brimstone".
• Can damage Fire Places and poops.

Lil Haunt

• Got renamed from "Lil' Haunt" to "Lil Haunt".

Lord of the Pit

• Its costume has color alts.

Lost Contact

• Only affects the player and Incubus's tears.

Lusty Blood

• Its costume has color alts.

Number One

• Causes Isaac to fire "tears" from the middle instead of from his eyes, and at a slightly lower height.

Ouija Board

• Its costume no longer overwrites the player's skin color to pink instead of white.

PHD

• Converts:
  • ??? into Telepills
  • Addicted into Percs!
  • Paralysis into Pheromones
  • Retro Vision into I can see forever!
  • R U A Wizard? into Power Pill!
  • X-Lax into Something's wrong...

Piggy Bank

• Its costume has color alts.

Purity

• Better visualization of Purity's glow.

Restock

• Purchasing an item that is on sale will replace it with another that is on sale.

Robo-Baby

• Can damage Fire Places and poops.

Rubber Cement

• Tears bounce off bombs.
• Spectral tears no longer bounce off rocks.

Sagittarius

• Its costume has color alts.

Scatter Bombs

• Bombs actually scatter around.
• Small bombs leave smaller craters.

The Small Rock

• The speed and tears changes will take effect immediately. Without Afterbirth+, they didn't immediately change until Isaac's speed or tears stats are updated the next time.

Steam Sale

• Items have a chance to be discounted further by random sales; for example, a discounted item originally costing 5 coins will then cost 2 coins instead of 3.

Sticky Bombs

• Its costume has color alts.

Succubus

• Grants its damage bonus when obtained via Cambion Conception.

Synthoil

• Its costume has color alts.

Trinkets

General

• Some sprites changed:

The Left Hand

• Affects Bomb Chests.

Safety Scissors

• Wrath and Super Wrath's bombs turn into their respective pickups.

Tick

• Can be removed by Smelter and Gulp!.

Interactions

• ? Card + Glowing Hourglass - The ? Card doesn't get refunded upon usage anymore.
• 9 Volt + The Candle - The Candle starts at half charge after use.
• A Lump of Coal + Athame - Damage to the ring of Athame is no longer reduced by half.
• A Lump of Coal + Maw Of The Void - Damage to the Maw ring is no longer reduced by half.
• Athame + Proptosis - The ring deals normal damage.
• Brimstone + Ipecac - Isaac shoots Ipecac tears while charging Brimstone. Isaac gains increased damage, decreased tears, and the poison effect.
• Car Battery + Mine Crafter - Spawns two TNT barrels.
• Cursed Eye + Incubus - A burst of tears is fired, but it does not need to be charged.
• Epic Fetus + Monstro's Lung - As of current version this synergy is bugged and only a single missile fires.
• Ipecac + The Ludovico Technique - +4 damage bonus, no explosion.
• Ipecac + Mom's Knife - Also adds +4 damage.
• The Ludovico Technique + Multidimensional Baby - An additional Ludovico tear is spawned when it passes through Multidimensional Baby, at the start of every room, and persists like the Ludovico tear itself.
• Maw Of The Void + Proptosis - The ring deals normal damage.

Pickups

General

• Can be picked up as soon as they hit the ground.
• Pickup velocities are seeded from machines, beggars, Tinted Rocks, chests, sacks, and bosses.

Hearts

Black Heart

• Has unique sounds.

Eternal Heart

• Takes half a heart worth of damage from any lethal hit taken with only Soul Hearts.

Gold Heart

• Turns nearby enemies to gold when breaking.
• Added better visual feedback when breaking.
• Minimap icon added.
• Has unique sounds.

Half Red Heart

• Minimap icon added.

Coins

Lucky Penny

• Has a green shine.

Bombs

Golden Bomb

• Has unique sounds.

Pills

Friends Till The End!

• Has narration.

Cards and Runes

? Card

• Its card ID is 48 instead of 43.

A Card Against Humanity

• Has a unique card back.

Chaos Card

• Has a unique card back.

Credit Card

• Has a unique card back.

Get out of Jail Free Card

• Has a unique card back.

Chests

General

• Items dropped no longer revert to their generic stone pedestal look upon leaving and reentering the room.

Locked Chest

• The Golden Chest pool also includes bags, such as IV Bag or Sack of Pennies.

Spiked Chest

• Spiked Chests will deal damage normally even in The Chest / Dark Room.

Entities

Monsters

General

• Champion enemies no longer deal contact damage if the non-champion version doesn't.
• Charmed enemies prioritize non-charmed enemies unless there aren't any.
• Permanently charmed enemies no longer try to go after Punching Bag.
• Permanently charmed enemies can shoot projectiles through each other and familiars.
• Monster replacements will now only occur with enemies spawned as part of the room layout.

Begotten

• Is chained to an adjacent rock if the nearest wall is more than 1 grid cell away.

Big Spider

• No longer blink when the player has Bursting Sack.

Blue Gaper

• Reduced Base HP and added stage HP.
• Has a proper appearance animation if spawned by a room rather than by a boss.

Conjoined Fatty

• Added extra sounds and effects to creep attacks.

Death's Head

• No longer deals contact damage during its death animation.

Greed Gaper

• Has a proper appearance animation if spawned by a room rather than by a boss.

Homunculus

• Is chained to an adjacent rock if the nearest wall is more than 1 grid cell away.

Lil Haunt

• Is no longer considered a boss.
• Has a unique death portrait.

Lump

• Its body is red when in the Scarred Womb.

Meatball

• Added extra sounds and effects to creep attacks.

Mega Clotty

• Make a sound when stomping.

Rage Creep

• Its brimstone is no longer moved upwards and no longer causes the player to take damage along the top wall in Womb/Utero room #202.
• Its attack animation slightly longer.

Spider

• No longer blink when the player has Bursting Sack.

Stone Grimace and all its variants

• Explodes into rock debris when killed with Chaos Card or Little Horn.

Stone Grimace

• Closes its eyes when the room is cleared.
• No longer respawn when reentering the room if killed.

Super Pooter

• Renamed from "Fat Fly" to "Super Pooter".

Mini-Bosses

Greed

• The Greed fight before Ultra Greed triggers the victory jingle when cleared.

Stone Grimace

• No longer plays its appear animation if encountered in an already cleared room.

Super Greed

• Can drop Head of the Keeper.

Swinger

• Spawns with its head retracted and extends over 2 seconds.

Bosses

Brownie

• Has new a champion version:
  • Black: Spawns up to 3 Chargers at once instead of Corns. Upon death, spawns 2 Dank Squirts.

The Cage

• Its grey creep blinks.

The Forsaken

• Moves to a more appropriate place to perform his Brimstone attack in L-shaped rooms.
• Multiple Forsakens in the same room can spawn their own Bony each and always spin their Brimstone attack in the same direction at the same speed.

The Haunt

• Champion variants are transparent during their first phase.

Hush

• Due to the way entity stacking works ??? may rarely appear instead and once defeated will skip "phase 2" entirely and will give a completion mark as if Hush was defeated.

Krampus

• Does a short dash towards the player before doing a spinning Brimstone attack.
• Can shoot Brimstone lasers in all 4 diagonal directions.

The Lamb

• No longer do its rotating Brimstone attack when close to a wall.

Little Horn

• Has new champion versions:
  • Orange: Spits out an orange Troll Bomb instead of a black ball. The bomb deals contact damage and leave a patch of fire similar to Hot Bombs.
  • Black: Does not attack with Pits or troll bombs, but fires smoke balls more frequently.

Mega Satan

• If The Void is unlocked, there is a 50% chance that the game will not immediately end, and Mega Satan will instead drop an ending chest along with a portal. Entering the chest ends the game and plays the cutscene while entering the portal will take Isaac to The Void.

Mom

• Familiars are teleported to the player's position when entering the boss room.

Rag Man

• Has new champion versions:
  • Black: Spawns 2 spiders instead of a Ragling. Uses his resurrect frequently. This won't resurrect anything since the spiders don't leave corpses but still heals him. Sprays tears during his resurrection, similar to Monstro's spit.
  • Red: No longer fires tears. Can have up to 4 Raglings at one time and can revive up to 2 Raglings at once.

Triachnid

• Has a death animation.

Creeps

Red creep

• No longer be darkened in the Scarred Womb.

Environment

General

• Added some backdrop tiling fixes.
• Pit seams are fixed.

Chapters

Womb

• Womb trapdoors have a new sprite for when they are closed.

???

• Additionally, an exit will spawn in the corner of the room, containing a Portal leading to The Void.

Cathedral

• Has a new floor transition animation.
• Some rooms contain Angel Statues that can be bombed to summon the Angels and acquire key pieces.

Rooms

Treasure Room

• There is a chance that 2-4 Greed Gapers may appear in the room.
• Treasure rooms can rarely contain two items that can both be taken or poop, trinket, and a couple of pickups instead of an item.
• New layouts:

Shop

• There is a 20% chance for Donation Machine to be replaced by Restock Machine.
• There is a small chance for the shop to be replaced by one of its two rare variants:

(the two pennies are lucky pennies)

Curse Room

• Can contain a Devil statue and a random item, surrounded by spikes.
• Minimap icon changed.

Sacrifice Room

• Minimap icon changed.
• New layout:

Secret Room

• New theme:
  • Angel Room: 3 Soul Hearts, 2 Blue Fire Places, Angel statue in center which does not drop key piece for respective angel.

Devil Room

• Can contain:
  • 4 deals with the Devil
  • 5 Red Chests
  • 3 Devil Beggars.
• Urns may spawn in the Devil Room.
• An angel statue can rarely substitute the Satan statue and can be awoken with an explosion.
  • Angels spawned in this way do not drop Key Pieces.
• Red Chests inside a Devil Room no longer teleport the player to the Devil Room.

Angel Room

• Can contain 5 Soul Hearts.
• Two angel statues can appear in the same room, allowing Isaac to fight both Uriel and Gabriel. It is possible to get both Key Pieces if Isaac awakes and fights each of them one by one; however, fighting both at once will only spawn one Key Piece corresponding to the last defeated angel.

Dice Room

• The 1 pip room re-rolls each of Isaac's passive items into a random item from the specific item pool where it was acquired.
• The 4 pips room rerolls item pedestals located in the Shop and the Library.
• Have a small icon in the corner of the room that denotes what the effect of the room is.

I AM ERROR

• Can contain two Blood Donation Machines, two Beggars, and two beds.

Boss Rush

• There is a small chance that there will be 8 items to choose from.
• Using the Black Rune will start the Boss Rush.
• New layout:

Crawl Space

• New layouts (rares):

Black Market

• Players can no longer access the Black Market through the wall glitch. However, it is still possible to access the Black Market using the glitch via special circumstances including having Ipecac and The Inner Eye.

Obstacles

Mushrooms

• Have a chance to spawn Mushrooms.

Reward Plate

• Locks the room when spawning enemies.

Pressure Plate

• No longer grants a charge when bombing out of its room.

Movable TNT

• Takes damage exactly like their regular counterparts.

Spikes

• No longer stay in their raised position when clearing Pressure Plate rooms.
• Start (and remain) in their lowered position when entering a cleared Pressure Plate room.

Machines

Donation Machine

• Donation gradually accelerates if the player stays in contact with the donation machine.

Greed Donation Machine

• No longer jams when the HUD displays a jamming rate of 0%.
• Donation gradually accelerates if the player stays in contact with the greed machine.

Slot Machine

• Items dropped no longer revert to their generic stone pedestal look upon leaving and reentering the room.

Challenges

• Killing Delirium will count as completing challenges.

I RULE!

• Gives only The Negative after defeating Mom, forcing you to progress through Sheol and the Dark Room instead of the Cathedral and The Chest.

Achievements

General

• Popups can be fast-forwarded by tapping Start.

New bugs/Fixed bugs

Bug!	If an angel statue is broken inside the devil room the door will incorrectly be shown to be open, but can't be escaped from

Bug!	When Scolex is slowed, some of his body parts may detach or won't even show up - they will only be visible while entering the ground (especially the tail).

The Binding of Isaac: Rebirth
Achievements Challenges Completion Marks Items Trinkets Characters Chapters Rooms Transformations Attributes Bosses Monsters Pickups Modes Curses Objects Seeds Effects Endings
Collection Item Pools Version History Modding Music