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Little Horn is smaller and similar to Loki both in design and somewhat in combat. He is grey-colored and sport with stubby limbs, short horns, red eyes, and a single sharp tooth from his bottom jaw.
He is occasionally seen floating around the room.
Little Horn constantly moves away from Isaac. He creates pits to throw regular or mega troll bombs into and causes them to randomly appear on screen. He also uses pits to randomly appear on screen. Little Horn may use a hole to relocate and leave a troll bomb in his place, he will do that many times. He spits smoking black balls to chase Isaac, the balls can be killed. He can create 3-5 moving pits that will hurt Isaac if he falls in one. Little Horn can also spawn one stationary hole that disappears after several seconds.
When Little Horn dies, he disappears into a hole in the floor with his red eyes flashing. The hole closes shortly after.
- Little Horn cannot summon holes if he's above the pits.
- Little Horn is one of the few Rebirth bosses to have a concept art. Two others being Dingle and Rag Man.
- Little Horn is named after the boss of the same name from one of Edmund's previous games, Super Meat Boy.
- Little Horn is created due to Edmund McMillen's love for Loki's design.
- Despite being a Cave boss as Edmund said, Little Horn is currently a Chapter 1 boss.
- Edmund also refers Little Horn as male.
- Little Horn is also named after the "eleventh horn" of the terrible ten-horned beast from Daniel's vision of the Bible. Eventually, it refers to the Antichrist.