The Binding of Isaac: Afterbirth †/Changes
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Menus
- 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.
- 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.
- 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.
- Starts with Cambion Conception only if it has been unlocked.
Transformations
- Its costume has color alts.
- Its costume has color alts.
- Its costume has color alts.
- 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:
| Item | Old sprite | New sprite |
|---|---|---|
| The Boomerang | 
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| Box of Spiders | 
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| D20 | 
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| D7 | 
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| Glass Cannon | 
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| Isaac's Tears | 
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| The Jar | 
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| Jar of Flies | 
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| Mega Blast | 
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| Ventricle Razor | 
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| We Need To Go Deeper! | 
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- Can be held down between rooms.
- Added some visual feedback when it provides its invincibility.
- 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?.
- Re-rolls each of Isaac's passive items into a random item from the specific item pool where it was acquired.
- No longer spawns extra items for empty item pedestals.
- Poops spawned react to damage similarly to regular poops.
- Can catch Lil Haunts.
- 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.
- The number of flies is seeded.
- Lasers no longer have a chance to rotate.
- Its sprite changes based on how many hearts it contains.
- Its sprite changes based on how many flies it contains.
- Spawns a TNT barrel directly at the player's position rather than on a nearby free tile.
- Its costume has color alts.
- Adjusted the contents in Greed mode.
- Plays its use animation.
- Damage halved to compensate.
- 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.
- Portals will now appear closed if they have no connected portal.
- Portals got a few minor visual tweaks.
Passive Collectibles
- General
- Some sprites changed:
- Decreased the damage rate of level 3 and 4 to match Cube of Meat.
- Self-recharging active items can charge the yellow meter, allowing Isaac to use them twice immediately.
- No longer triggers if there are fewer than 2 enemies in the room.
- Its costume has color alts.
- Increases spawner familiar spawn rates.
- Makes the darkness from Curse of Darkness fade away instead of immediately lighting the room up.
- Its costume has color alts.
- Its costume has color alts.
- Its costume has color alts.
- Its costume has color alts.
- The multiplier will no longer be lost when hitting poops or TNT barrels.
- Poops spawned react to damage similarly to regular poops.
- Is now limited to a maximum of 10 to prevent potential crashes.
- 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.
- Its costume has color alts.
- New possible effects:
- Added extra familiar animations.
- The effect also applies to locusts.
- Its costume has color alts.
- The shield is no longer restored if the player saves and continues after losing it.
- Its costume has color alts.
- Will drop from angels that are not in Angel Rooms.
- Causes Isaac to fire "tears" from the middle instead of from his eyes, and at a slightly lower height.
- Got renamed from "Lil' Brimstone" to "Lil Brimstone".
- Can damage Fire Places and poops.
- Got renamed from "Lil' Haunt" to "Lil Haunt".
- Its costume has color alts.
- Only affects the player and Incubus's tears.
- Its costume has color alts.
- Causes Isaac to fire "tears" from the middle instead of from his eyes, and at a slightly lower height.
- Its costume no longer overwrites the player's skin color to pink instead of white.
- 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...
- Its costume has color alts.
- Better visualization of Purity's glow.
- Purchasing an item that is on sale will replace it with another that is on sale.
- Can damage Fire Places and poops.
- Tears bounce off bombs.
- Spectral tears no longer bounce off rocks.
- Its costume has color alts.
- Bombs actually scatter around.
- Small bombs leave smaller craters.
- 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.
- 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.
- Its costume has color alts.
- Grants its damage bonus when obtained via Cambion Conception.
- Its costume has color alts.
Trinkets
- General
- Some sprites changed:
- Affects Bomb Chests.
- Wrath and Super Wrath's bombs turn into their respective pickups.
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
- Has unique sounds.
- Takes half a heart worth of damage from any lethal hit taken with only Soul Hearts.
- Turns nearby enemies to gold when breaking.
- Added better visual feedback when breaking.
- Minimap icon added.
- Has unique sounds.
- Minimap icon added.
Coins
- Has a green shine.
Bombs
- Has unique sounds.
Pills
- Has narration.
Cards and Runes
- Its card ID is 48 instead of 43.
- Has a unique card back.
- Has a unique card back.
- Has a unique card back.
- Has a unique card back.
Chests
- General
- Items dropped no longer revert to their generic stone pedestal look upon leaving and reentering the room.
- The Golden Chest pool also includes bags, such as IV Bag or Sack of Pennies.
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.
- Is chained to an adjacent rock if the nearest wall is more than 1 grid cell away.
- No longer blink when the player has Bursting Sack.
- Reduced Base HP and added stage HP.
- Has a proper appearance animation if spawned by a room rather than by a boss.
- Added extra sounds and effects to creep attacks.
- No longer deals contact damage during its death animation.
- Has a proper appearance animation if spawned by a room rather than by a boss.
- Is chained to an adjacent rock if the nearest wall is more than 1 grid cell away.
- Is no longer considered a boss.
- Has a unique death portrait.
- Its body is red when in the Scarred Womb.
- Added extra sounds and effects to creep attacks.
- Make a sound when stomping.
- 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.
- 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.
- Closes its eyes when the room is cleared.
- No longer respawn when reentering the room if killed.
- Renamed from "Fat Fly" to "Super Pooter".
Mini-Bosses
- The Greed fight before Ultra Greed triggers the victory jingle when cleared.
- No longer plays its appear animation if encountered in an already cleared room.
- Can drop Head of the Keeper.
- Spawns with its head retracted and extends over 2 seconds.
Bosses
- Has new a champion version:
- Black: Spawns up to 3 Chargers at once instead of Corns. Upon death, spawns 2 Dank Squirts.
- Its grey creep blinks.
- 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.
- Champion variants are transparent during their first phase.
- 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.
- Does a short dash towards the player before doing a spinning Brimstone attack.
- Can shoot Brimstone lasers in all 4 diagonal directions.
- No longer do its rotating Brimstone attack when close to a wall.
- 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.
- 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.
- Familiars are teleported to the player's position when entering the boss room.
- 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.
- Has a death animation.
Creeps
- No longer be darkened in the Scarred Womb.
Environment
- General
- Added some backdrop tiling fixes.
- Pit seams are fixed.
Chapters
- 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.
- Has a new floor transition animation.
- Some rooms contain Angel Statues that can be bombed to summon the Angels and acquire key pieces.
Rooms
- There is a chance that 2-3 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:
- 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)
- Minimap icon changed.
- New layout:
- New theme:
- Angel Room: 3 Soul Hearts, 2 Blue Fire Places, Angel statue in center which does not drop key piece for respective angel.
- Can contain:
- 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.
- 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.
- 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.
- Can contain two Blood Donation Machines, two Beggars, and two beds.
- 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:
- New layouts (rares):
- 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
- Have a chance to spawn Mushrooms.
- Locks the room when spawning enemies.
- No longer grants a charge when bombing out of its room.
- Takes damage exactly like their regular counterparts.
- 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 gradually accelerates if the player stays in contact with the 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.
- 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.
- 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.