Familiar

Familiars are small companions, usually generated by passive items, that follow and assist the character. Effects of familiars include (but are not limited to) pickup generation, shooting familiars that fire their own tears at enemies, and orbitals that act as projectile shields and/or deal contact damage.

Temporary Familiars

Blue Flies

Blue Flies are familiars that will orbit around Isaac and rush towards nearby enemies, dealing damage and dying in the process. Blue flies deal double Isaac's current tear damage. Isaac cannot have more than 64 Blue Flies/Spiders combined.

Name	ID	Icon	Quote	Description
Guppy's Head	145		Reusable fly hive	Spawns 2-4 Blue Flies to damage enemies.
Jar of Flies	434		Gotta catch 'em all?	Every time Isaac kills an enemy, a fly will be added to the jar, up to a maximum of 20. Using the Jar of Flies will release all the flies that are currently in the jar as friendly blue flies that will damage enemies.
Compost	480		Gain more friends!	Doubles Isaac's Blue Spiders and Flies, or spawns one if Isaac has none. Turns pickups in the room into Blue Spiders or Flies.

Name	ID	Icon	Quote	Description
Infestation	148		They grow inside	1-3 Blue Flies randomly spawn every time Isaac gets hit.
Rotten Baby	268		Infested friend	A familiar that spawns blue flies.
The Mulligan	151		They grow inside	Tears have a 1/6 chance of spawning allied blue flies when they hit an enemy.
Parasitoid	461		Egg tears!	Adds a chance to fire an egg sack which spawns slowing creep and spawns a blue fly or spider upon hitting an enemy.

Name	ID	Icon	Quote	Description
Fish Head	29		It stinks	Spawns a Blue Fly every time Isaac takes damage.
Lil Larva	86		The poop is moving...	Spawns a blue fly from every pile of poop that Isaac destroys.
Fish Tail	94		It also stinks!	Items and trinkets that generate Blue Flies or Blue Spiders will generate twice as many.
Rotten Penny	126		Wealth of flies	Spawns a blue fly every time a coin is picked up.

Other sources of Blue Flies

• Red Chest: Has a chance to spawn 3 Blue Flies.
• Dark blue champion: Will create 3 Blue Flies when defeated.
• Guppy transformation: Isaac will create Blue Flies whenever his tears or his familiars' tears hit enemies.
• Beelzebub transformation: All enemy flies become Blue Flies.
• Berkano: Spawns 3 Blue Flies and 3 Blue Spiders upon use.
• Friends Till The End! pill: Spawns three Blue Flies.
• As Keeper, all heart pickups turn into Blue Flies.
• Black Rune: Turns pickups into Blue Flies and Blue Spiders.

Locusts

Locusts are variants of Blue Flies that are spawned by Locust trinkets and 7 Seals. They behave like regular Blue Flies but have additional special effects. Red Locusts explode on contact with an enemy, dealing an extra 60 damage in the radius. Green Locusts poison the enemy. Yellow Locusts slow the enemy. Black Locusts deal quadruple Isaac's damage instead of double. White Locusts are identical to Blue Flies, but are spawned in high quantities.

Name	ID	Icon	Quote	Description
7 Seals	526		Lil harbingers!	Grants a random Harbinger familiar that changes every 10 seconds. Harbingers have different behaviors and spawn themed Locusts.

Name	ID	Icon	Quote	Description
Locust of Conquest	117		I bring Conquest	Upon entering a room with enemies, spawns 2-5 White Locusts which damage enemies.
Locust of Death	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	115		I bring Famine	Upon entering a room with enemies, spawns a Yellow Locust that damages and slows enemies.
Locust of Pestilence	114		I bring Pestilence	Upon entering a room with enemies, spawns a Green Locust which damages and poisons enemies.
Locust of War	113		I bring War	Upon entering a room with enemies, spawns a Red Locust which detonates upon impact with enemies.

Blue Spiders

Blue Spiders are familiars similar to Blue Flies that crawl erratically and rush towards nearby enemies, dealing damage and dying in the process. Blue Spiders deal 2.5 times Isaac's current tear damage. Unlike Blue Flies, Blue Spiders cannot attack over obstacles such as rocks and pits. Isaac cannot have more than 64 Blue Flies/Spiders combined.

Bug!  3DS  Exiting the game and re-entering will cause all Blue Spiders to disappear.

Name	ID	Icon	Quote	Description
Box of Spiders	288		It's a box of spiders	Summons 2-4 Blue Spiders.
Compost	480		Gain more friends!	Doubles Isaac's Blue Spiders and Flies, or spawns one if Isaac has none. Turns pickups in the room into Blue Spiders or Flies.

Name	ID	Icon	Quote	Description
Dark Bum	278		He wants to take your life	Spawns a familiar that follows Isaac around and collects Red Hearts. For every one-and-a-half Red Hearts collected, Dark Bum will generate one Soul Heart, one hostile Spider or one friendly Blue Spider.
Infestation 2	234		Infestation shot	Spawns allied Blue Spiders from killed enemies.
Juicy Sack	266		Sticky babies	A familiar that follows behind Isaac. It drips a trail of creep, which slows enemies, and spawns 1-2 blue spiders after each room.
Mom's Wig	217		You feel itchy...	Adds a chance to spawn blue spiders when firing tears. Restores 1 red heart.
Sissy Longlegs	280		She loves you	Wanders about the room, occasionally spawning Blue Spiders.
Spider Baby	211		Spider revenge	When hit, spawns up to 2 Blue Spiders.
Spider Mod	403		Mod buddy!	Displays Isaac's tear damage and enemy health bars. Spawns a gray spider familiar that wanders around and inflicts a random status effect on any enemies it comes into contact with. Occasionally spawns a blue spider upon clearing a room.
Sticky Bombs	367		Egg sack bombs!	+5 bombs. Bombs stick to enemies and spawn 2-4 Blue Spiders if they kill an enemy.
Parasitoid	461		Egg tears!	Adds a chance to fire an egg sack which spawns slowing creep and spawns a blue fly or spider upon hitting an enemy.

Other sources of Blue Spiders

• Berkano: Spawns 3 Blue Flies and 3 Blue Spiders upon use.
• Infested? pill: Spawns Blue Spiders equal to the number of enemies in the room.
• Infested! pill: Spawns a Blue Spider under Isaac and every pile of poop in the room.

Chasing Familiars

Familiars in this category actively chase enemies, dealing contact damage to them.

Name	ID	Icon	Quote	Description
The Pinking Shears	107		Cut and Run	Separates Isaac's head and body for the current room. Isaac's head, which now has flight, will be under the player's control, while his body will seek out enemies to attack by contact damage.

Name	ID	Icon	Quote	Description
Ball of Bandages	207		Gotta lick 'em all!	Orbiting familiar that deals damage to enemies. If collected while already having one, makes the familiar evolve. Only drops from Horsemen. Similar to Cube of Meat.
Cube of Meat	73		Gotta meat 'em all!	Orbiting familiar that blocks enemy shots and deals damage to enemies. If collected while already having one, it makes the familiar evolve. Only drops from Horsemen. Similar to Ball of Bandages.
Daddy Longlegs	170		Daddy's love	Daddy Long Legs' shadow follows Isaac and stomps on enemies.
Dead Bird	117		Protective buddy	Spawns a flying familiar for the current room that chases enemies whenever Isaac takes damage.
Gemini	318		Conjoined friend	Suture becomes attached to Isaac, and does touch damage to enemies within its attacking range.
Leech	270		Blood sucker	Spawns a friendly familiar leech on the ground that hunts down enemies. Isaac heals for half a heart whenever Leech kills an enemy.
Lil Haunt	277		Fear him	A familiar that damages enemies by chasing them as well as inducing the fear effect.
Smart Fly	264		Revenge fly	After Isaac takes damage, this fly will do continuous touch damage to whatever enemy caused the damage until it is dead. The fly will then systematically attack 1 enemy at a time until the room is cleared.
Bumbo	385		Bumbo want coin!	Spawns a Beggar familiar which floats around the room and 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 chases enemies slowly, doing contact damage.

Name	ID	Icon	Quote	Description
Eve's Bird Foot	60		Revenge from beyond	5% chance to spawn a Dead Bird familiar for the current room each time an enemy dies.

Note: Only third and fourth stage Cube of Meat and Ball of Bandages chase enemies.

Note: Only fourth stage Bumbo chases enemies.

Orbital Familiars

Familiars that orbit Isaac, absorbing enemy projectiles and dealing contact damage. Despite their different apparent sizes, most of them have the same effective size with regard of blocking shots or damaging enemies.

Name	ID	Icon	Quote	Description
Ball of Bandages	207		Gotta lick 'em all!	Orbiting familiar that deals damage to enemies. If collected while already having one, makes the familiar evolve. Only drops from Horsemen. Similar to Cube of Meat.
Best Bud	274		Sworn protector	When hit, summons a white attack fly similar to Distant Admiration for the current room.
Big Fan	279		Fat protector	Spawns a large orbital familiar that blocks enemy projectiles and deals slight contact damage to enemies.
Cube of Meat	73		Gotta meat 'em all!	Orbiting familiar that blocks enemy shots and deals damage to enemies. If collected while already having one, it makes the familiar evolve. Only drops from Horsemen. Similar to Ball of Bandages.
Distant Admiration	57		Attack fly	A red attack fly circles further out than the Halo of Flies / Pretty Flies, but closer than Forever Alone. Deals more damage than Forever Alone.
Forever Alone	128		Attack fly	Spawns a blue attack fly that orbits a long distance from Isaac.
Guardian Angel	112		Extra protection	Spawns an orbital familiar that blocks enemy projectiles, deals contact damage to enemies, and increases the speed of all orbital familiars.
Halo of Flies	10		Projectile protection	Spawns two Pretty Flies that block enemy shots and deal contact damage to enemies.
Sacrificial Dagger	172		My fate protects me	A dagger orbits Isaac, dealing very high damage and blocking enemy shots.
Smart Fly	264		Revenge fly	After Isaac takes damage, this fly will do continuous touch damage to whatever enemy caused the damage until it is dead. The fly will then systematically attack 1 enemy at a time until the room is cleared.
Friend Zone	364		Friendly fly	A white orbiting fly which deals 3 contact damage per tick to enemies. This familiar orbits Isaac at a middle length distance somewhere between Distant Admiration and Forever Alone.
Sworn Protector	363		Protective friend	An orbital angel which does 7 contact damage per tick and attracts and blocks enemy shots. Upon blocking 10 shots in a room it drops an Eternal Heart.
Bloodshot Eye	509		Bloody friend	Spawns an orbiting eye familiar that deals contact damage and fires tears every 2 seconds.
Mom's Razor	508		It's sharp!	Spawns an orbiting razor that damages enemies it touches and inflicts bleeding on enemies, causing them to slowly take damage over time.
Slipped Rib	542		Projectile shield	Spawns a bone familiar that circles around Isaac and reflects enemy shots.

Pills / Slot Machine

Name	Description
Pretty Fly	Grants 1 fly orbital that circles the player, blocking projectiles and damaging fly-type enemies on touch.

Notes

• A maximum of three Pretty Flies can orbit around Isaac.
  • It is possible to have more than three orbitals if one has access to co-op mode. If a co-op baby or multiple co-op babies temporarily hold all but two orbitals while Isaac picks up another, and then the co-op baby or co-op babies sign out or die, Isaac will receive their orbitals as well.
• Cube of Meat, Ball of Bandages, and Sacrificial Dagger take up a Pretty Fly slot.
  • For example, If Isaac has three Pretty Flies and picks up a Cube of Meat, the Cube of Meat will replace one of the flies.
  • Only first and second stage Cube of Meat and Ball of Bandages are orbitals. Therefore, upgrading from level 2 to level 3 will free up a Pretty Fly slot.
• Duplicated orbitals, such as Forever Alone being copied with the Box of Friends or Diplopia, will fly directly opposite the original (having three copies will cause them to fly 120 degrees apart, four will fly at 90 degrees and so on).

Trivia

• Pretty Fly is a play on the phrase "pretty fly" as a descriptor.

Pickup Generation Familiars

Familiars that generate pickups when certain conditions are met.

Name	ID	Icon	Quote	Description
Bomb Bag	131		Gives bombs	Isaac is followed by a small bag that drops a Bomb, a Double Bomb, a Troll Bomb, or a Golden Bomb every 3 rooms.
Bum Friend	144		He's greedy	A portable Beggar who follows Isaac, picks up coins for himself, and occasionally drops a pickup after collecting a coin. Does not spawn collectibles.
Dark Bum	278		He wants to take your life	Spawns a familiar that follows Isaac around and collects Red Hearts. For every one-and-a-half Red Hearts collected, Dark Bum will generate one Soul Heart, one hostile Spider or one friendly Blue Spider.
Little C.H.A.D.	96		Gives kisses	A familiar who will drop a half red heart every 3 rooms.
Mystery Sack	271		?	Spawns a familiar that drops a heart, coin, bomb, or key every 5-6 rooms.
Sack of Pennies	94		Gives money	Isaac is followed by a small bag that drops a coin every 2 rooms.
The Relic	98		Soul generator	Isaac is followed by a small blue cross that will drop a Soul Heart every 5-6 rooms.
Bumbo	385		Bumbo want coin!	Spawns a Beggar familiar which floats around the room and 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 chases enemies slowly, doing contact damage.
Charged Baby	372		Bbbzzzzzt!	A battery familiar that occasionally drops a Lil' Battery, gives an active item charge, or freezes all enemies in the room.
Key Bum	388		He wants your keys!	Spawns a portable key master that follows Isaac and collects keys, giving random chests in return.
Lil Chest	362		What's in the box?	Spawns a chest familiar that follows Isaac and drops a random pickup every few rooms.
Rune Bag	389		Rune generator	A bag that follows Isaac and drops a random rune every 5-6 rooms.
Acid Baby	491		Pills pills pills!	Spawns a familiar that drops random pills every 3 rooms cleared. Upon using a pill, all enemies in the room are poisoned.
Sack of Sacks	500		Gives sacks	Spawns a sack familiar that drops a sack every 5-6 rooms cleared.

Spawning Familiars

Familiars that spawn friendly Blue Spiders or Blue Flies.

Name	ID	Icon	Quote	Description
Dark Bum	278		He wants to take your life	Spawns a familiar that follows Isaac around and collects Red Hearts. For every one-and-a-half Red Hearts collected, Dark Bum will generate one Soul Heart, one hostile Spider or one friendly Blue Spider.
Juicy Sack	266		Sticky babies	A familiar that follows behind Isaac. It drips a trail of creep, which slows enemies, and spawns 1-2 blue spiders after each room.
Rotten Baby	268		Infested friend	A familiar that spawns blue flies.
Sissy Longlegs	280		She loves you	Wanders about the room, occasionally spawning Blue Spiders.

Shooting Familiars

Familiars that attack with their own tears as long as Isaac is attacking or charging a shot.

Name	ID	Icon	Quote	Description
Scissors	325		Lose your head	Upon use, turns Isaac's head into a stationary familiar for the current room which fires normal tears that deal 3.5 damage.

Name	ID	Icon	Quote	Description
Abel	188		Mirrored buddy	A familiar that mirrors the player's movements and shoots in the opposite direction.
Ball of Bandages	207		Gotta lick 'em all!	Orbiting familiar that deals damage to enemies. If collected while already having one, makes the familiar evolve. Only drops from Horsemen. Similar to Cube of Meat.
Brother Bobby	8		Friends 'till the end	Follows Isaac around shooting normal tears.
Cain's Other Eye	319		Near-sighted friend	Spawns a familiar that floats slowly around the room on a zig-zag pattern similar to The Peeper and shoots normal tears in the same direction as Isaac.
Cube of Meat	73		Gotta meat 'em all!	Orbiting familiar that blocks enemy shots and deals damage to enemies. If collected while already having one, it makes the familiar evolve. Only drops from Horsemen. Similar to Ball of Bandages.
Demon Baby	113		Auto-turret friend	Follows Isaac and automatically fires at enemies in its reach.
Ghost Baby	163		Spectral buddy	Spawns a familiar that follows Isaac around and fires spectral tears.
Harlequin Baby	167		Double shot buddy	Spawns a familiar that follows Isaac around and fires two tears at once in a V-pattern.
Lil Brimstone	275		Evil Friend	A Familiar that shoots a thin Brimstone beam. Must charge like Brimstone before shooting.
Little Gish	99		Sticky friend	Spawns a familiar that follows Isaac around and fires slowing tears, impeding enemies' speed.
Little Steven	100		Psychic friend	Spawns a familiar that follows Isaac around and fires homing tears.
Mongo Baby	322		Mongo Friend	Summons a familiar that copies the tears of Isaac's other familiars.
Rainbow Baby	174		Random buddy	Spawns a familiar that follows Isaac around and fires tears with random effects.
Robo-Baby	95		Friends 'till the bbbbzzzt	Follows Isaac around, shooting enemies with an eye laser similar to Technology.
Robo-Baby 2.0	267		We worked out all the kinks	Fires lasers at any enemy in its line of sight and moves based on the direction Isaac is firing tears.
Sister Maggy	67		Friends 'till the end	A familiar that follows Isaac around shooting blood tears.
Fate's Reward	361		Your fate beside you	A blue head familiar that will follow Isaac and fire tears copying his tear effects and damage.
Incubus	360		Dark friend	A demonic familiar that follows Isaac and shoots tears identical to Isaac's in terms of damage, range, fire rate, and effects.
Lil' Loki	435		4-way buddy!	A Loki familiar that follows Isaac and shoots 4 tears in a cross pattern.
Seraphim	390		Sworn friend	An angel familiar which follows Isaac and fires homing tears which deal 10 damage and have -25% shot speed.
Buddy in a Box	518		What could it be?!	Grants a familiar with a random tear effect. The familiar is randomized at the start of each floor.
Lil Monstro	471		Ain't he cute?	Spawns a familiar that fires clusters of tears. Must be charged before shooting.

Name	ID	Icon	Quote	Description
???'s Soul	57		Imaginary Friend	Spawns a familiar that floats slowly around the room on a pattern similar to The Peeper and fires spectral and homing tears.
Isaac's Head	54		Dead friend	Gives the player Isaac's severed head as a tear-firing familiar. Fires piercing tears.
Umbilical Cord	33		Fetal Protection	When Isaac's health is brought to half a red heart and no soul hearts, a Little Steven familiar spawns for the current room.

Note: Only second stage Cube of Meat and Ball of Bandages shoot tears.
Note: Demon Baby shoots tears even when Isaac is not attacking.

Others

Familiars that don't fit into any of the above categories or that produce multiple effects.

Name	ID	Icon	Quote	Description
Brown Nugget	504		Friendly fly	Spawns a stationary fly familiar that fires tears at nearby enemies.
Sprinkler	516		Sprinkles.	Upon use, spawns a sprinkler that rotates and fires tears.

Name	ID	Icon	Quote	Description
1up!	11		Extra life	Gives Isaac an extra life. Upon death, he will respawn in the previous room with full health and lose the 1up!.
BBF	272		Big Beautiful Fly	Spawns a familiar that flies around the room like the Boom Fly and explodes on contact with an enemy. Respawns after ten seconds.
Bob's Brain	273		Explosive thoughts	Spawns a familiar that charges forward when shooting tears and explodes upon contact with an enemy, damaging and poisoning them. The familiar respawns after a few seconds.
Dead Cat	81		9 lives	Sets Isaac's Red Heart containers to 1, but gives Isaac 9 extra lives. After dying, Isaac respawns with 1 Red Heart in the last safe room.
Dry Baby	265		Immortal Friend	Spawns a familiar that follows Isaac around and blocks enemy projectiles. Upon blocking a shot, it has a chance of triggering The Necronomicon effect.
Guppy's Hair Ball	187		Swing it	Loosely follows behind Isaac. It can be swung like a flail by rapidly spinning Isaac in a circle. Grows bigger by killing enemies.
Headless Baby	269		Bloody Friend	Familiar that follows Isaac, leaving blood creep on the ground.
Holy Water	178		Splash!	Spawns a bottle familiar that breaks when Isaac takes damage, leaving a puddle of blue creep. The bottle is reformed upon entering a different room.
Isaac's Heart	276		Protect It	Isaac himself is now immune to all damage, and a heart familiar appears and follows Isaac. If the heart is hurt, Isaac is hurt.
Key Piece 1	238		???	Combined with Key Piece 2, unlocks the golden gate in the starting room of The Chest and Dark Room to fight Mega Satan.
Key Piece 2	239		???	Combined with Key Piece 1, unlocks the golden gate in the starting room of The Chest and Dark Room to fight Mega Satan.
Little Chubby	88		Attack Buddy	A charger familiar that charges forward and deals touch damage to any enemies in its path.
Punching Bag	281		Scape Goat	Spawns a Mulligan Familiar that will wander the room randomly. Enemies will attack the Mulligan if it's closer.
Samson's Chains	321		The ol' ball and chain	Spawns a ball and chain familiar Isaac pulls behind him that damages enemies, blocks shots, and destroys rocks.
The Peeper	155		Plop!	Spawns a familiar that floats slowly around the room on a zig-zag pattern similar to Boom Flies damaging enemies it passes through.
Censer	387		Peace be with you	Gives Isaac a golden censer familiar which creates a huge aura of light that slows down any enemies and enemy shots inside it.
Farting Baby	404		It farts!	A familiar that follows Isaac and blocks tears. If a tear hits Farting Baby, there is a high chance for it to fart, which will either knockback, poison, or charm all nearby enemies.
GB Bug	405		Game breaking bug, right away!	A glitch familiar that bounces around the room and applies a random status effect to any enemies it comes into contact with and has a chance to re-roll pickups that it passes over.
Lil Gurdy	384		A gurd of your own!	Gives Isaac a Gurdy familiar that will charge around the room dealing contact damage to enemies. Lil Gurdy is charged by holding down a fire button and letting go. The longer the button is held, the faster Lil Gurdy will fling itself across the screen. Lil Gurdy can pass over objects and obstacles in the room.
Lost Fly	365		Lost protector	A familiar fly that moves in a straight line and attaches itself to the first obstacle or wall it comes into contact within each room. If any enemies walk into its path, it will do 7 contact damage per tick. If the obstacle it is attached to is destroyed then it will continue rolling in the direction it was previously traveling until it meets another wall or obstacle.
Milk!	436		Don't cry over it...	A glass of milk follows Isaac and spills on the floor upon taking damage. After the milk spills, Isaac's tear delay is decreased by 2 for the rest of the room.
Multidimensional Baby	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.
Obsessed Fan	426		Follows my every move...	A purple fly familiar that follows Isaac's movements on a 3 second delay and deals contact damage to enemies.
Papa Fly	430		Turret follower	A blue fly familiar follows Isaac's movements on a 3 second delay. Papa Fly will fire tears at nearby enemies.
Spider Mod	403		Mod buddy!	Displays Isaac's tear damage and enemy health bars. Spawns a gray spider familiar that wanders around and inflicts a random status effect on any enemies it comes into contact with. Occasionally spawns a blue spider upon clearing a room.
Succubus	417		Damage booster	Spawns a flying familiar that bounces around the room with a black aura, dealing rapid damage to any enemies inside it. While standing in the aura, Isaac gains a 1.5x tear damage multiplier.
7 Seals	526		Lil harbingers!	Grants a random Harbinger familiar that changes every 10 seconds. Harbingers have different behaviors and spawn themed Locusts.
Angelic Prism	528		Eclipsed by the moon	Grants a prism orbital with a large orbital radius. Tears that pass through the prism split into four multi-colored tears.
Angry Fly	511		He's violent	Spawns a fly familiar that orbits around a random enemy and deals 5 damage per tick to enemies it comes in contact with.
Big Chubby	473		Chub chub	Spawns a fat charger familiar that slowly charges forward, blocking shots and damaging enemies in its path.
Depression	469		:(	Spawns a cloud familiar that leaves a trail of tears that damages enemies. Has a chance to spawn damaging beams of light onto enemies that touch the cloud.
Finger!	467		Watch where you point that!	Spawns a finger familiar that points at enemies, dealing constant damage.
Hushy	470		Lil hush!	Spawns a Hush familiar that bounces around the room and deals contact damage. While firing tears, it stops moving.
Jaw Bone	548		Fetch!	Spawns a familiar that flies the room while firing, dealing a flat 7 damage to enemies that come in contact and retrieving pickups.
King Baby	472		Lord of the dead!	Spawns a familiar that follows Isaac and makes other familiars follow it. While firing tears, it stops moving.
Lil Delirium	519		Delirious friend	Grants a familiar that transforms into another random familiar every 10 seconds.
[[Lil Spewer|]]	537	[[file:|45x45px|link=Lil Spewer|]]	Puking buddy	Spawns a random pill, and grants a small Spewer familiar that charges up and fires creep. Using pills changes the creep type.
Mystery Egg	539		Sacrificial insemination	Spawns an egg familiar, which cracks and turns into a random friendly enemy when Isaac is hurt. The egg regenerates upon entering a different room.
Pointy Rib	544		Stabbing time	Spawns a bone familiar that can be aimed with the fire buttons and does contact damage.
Shade	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.
YO LISTEN!	492		Yo listen!	+1 luck. Spawns a fairy familiar that points out secret room entrances and tinted rocks.

Name	ID	Icon	Quote	Description
Mom's Toenail	16		???	Once a minute, Mom's foot randomly stomps down somewhere in the room.
Tonsil	97		Sick...	When hit, there is a small chance a removed tonsil familiar starts following Isaac, blocking enemy shots.

Unlockable Achievements

• 

  Buddy in a Box - Pick up 5 familiars in a single run.

• 

  Rotten Penny - Have 20 Blue Flies at the same time.