diff --git a/CHANGELOG.md b/CHANGELOG.md
index 04a4c10b7c..0f9f1ed6bf 100644
--- a/CHANGELOG.md
+++ b/CHANGELOG.md
@@ -48,6 +48,9 @@ Increment the:
 * [CODE HEALTH] Fix clang-tidy macro to enum warnings
   [#3922](https://github.com/open-telemetry/opentelemetry-cpp/pull/3922)
 
+* [CODE HEALTH] Fix clang-tidy performance enum size warnings
+  [#3923](https://github.com/open-telemetry/opentelemetry-cpp/pull/3923)
+
 Important changes:
 
 * [BUILD] Revisit EventLogger deprecation
diff --git a/api/include/opentelemetry/common/attribute_value.h b/api/include/opentelemetry/common/attribute_value.h
index 342e889061..a00c18720e 100644
--- a/api/include/opentelemetry/common/attribute_value.h
+++ b/api/include/opentelemetry/common/attribute_value.h
@@ -57,7 +57,11 @@ using AttributeValue =
                    nostd::span<const uint64_t>,
                    nostd::span<const uint8_t>>;
 
-enum AttributeType
+#if OPENTELEMETRY_ABI_VERSION_NO >= 2
+enum AttributeType : std::uint8_t
+#else
+enum AttributeType  // NOLINT(performance-enum-size)
+#endif
 {
   kTypeBool,
   kTypeInt,
diff --git a/api/include/opentelemetry/trace/span_metadata.h b/api/include/opentelemetry/trace/span_metadata.h
index d2d6a9f85d..a138026bdb 100644
--- a/api/include/opentelemetry/trace/span_metadata.h
+++ b/api/include/opentelemetry/trace/span_metadata.h
@@ -6,11 +6,19 @@
 #include "opentelemetry/common/timestamp.h"
 #include "opentelemetry/version.h"
 
+#if OPENTELEMETRY_ABI_VERSION_NO >= 2
+#  include <cstdint>
+#endif
+
 OPENTELEMETRY_BEGIN_NAMESPACE
 namespace trace
 {
 
-enum class SpanKind
+#if OPENTELEMETRY_ABI_VERSION_NO >= 2
+enum class SpanKind : std::uint8_t
+#else
+enum class SpanKind  // NOLINT(performance-enum-size)
+#endif
 {
   kInternal,
   kServer,
@@ -24,7 +32,11 @@ constexpr char kSpanKey[]       = "active_span";
 constexpr char kIsRootSpanKey[] = "is_root_span";
 
 // StatusCode - Represents the canonical set of status codes of a finished Span.
-enum class StatusCode
+#if OPENTELEMETRY_ABI_VERSION_NO >= 2
+enum class StatusCode : std::uint8_t
+#else
+enum class StatusCode  // NOLINT(performance-enum-size)
+#endif
 {
   kUnset,  // default status
   kOk,     // Operation has completed successfully.
diff --git a/exporters/otlp/include/opentelemetry/exporters/otlp/otlp_http.h b/exporters/otlp/include/opentelemetry/exporters/otlp/otlp_http.h
index 6899c6f544..9536a8b853 100644
--- a/exporters/otlp/include/opentelemetry/exporters/otlp/otlp_http.h
+++ b/exporters/otlp/include/opentelemetry/exporters/otlp/otlp_http.h
@@ -3,6 +3,8 @@
 
 #pragma once
 
+#include <cstdint>
+
 #include "opentelemetry/nostd/string_view.h"
 #include "opentelemetry/version.h"
 
@@ -12,14 +14,14 @@ namespace exporter
 namespace otlp
 {
 
-enum class JsonBytesMappingKind
+enum class JsonBytesMappingKind : std::uint8_t
 {
   kHexId,
   kHex,
   kBase64,
 };
 
-enum class HttpRequestContentType
+enum class HttpRequestContentType : std::uint8_t
 {
   kJson,
   kBinary,
diff --git a/exporters/otlp/include/opentelemetry/exporters/otlp/otlp_preferred_temporality.h b/exporters/otlp/include/opentelemetry/exporters/otlp/otlp_preferred_temporality.h
index d9e4013fd5..12a05de9dd 100644
--- a/exporters/otlp/include/opentelemetry/exporters/otlp/otlp_preferred_temporality.h
+++ b/exporters/otlp/include/opentelemetry/exporters/otlp/otlp_preferred_temporality.h
@@ -2,6 +2,9 @@
 // SPDX-License-Identifier: Apache-2.0
 
 #pragma once
+
+#include <cstdint>
+
 #include "opentelemetry/version.h"
 
 OPENTELEMETRY_BEGIN_NAMESPACE
@@ -10,7 +13,7 @@ namespace exporter
 namespace otlp
 {
 
-enum class PreferredAggregationTemporality
+enum class PreferredAggregationTemporality : std::uint8_t
 {
   kUnspecified,
   kDelta,
diff --git a/exporters/zipkin/include/opentelemetry/exporters/zipkin/zipkin_exporter_options.h b/exporters/zipkin/include/opentelemetry/exporters/zipkin/zipkin_exporter_options.h
index 45cfef45dc..1d4f7a4a7e 100644
--- a/exporters/zipkin/include/opentelemetry/exporters/zipkin/zipkin_exporter_options.h
+++ b/exporters/zipkin/include/opentelemetry/exporters/zipkin/zipkin_exporter_options.h
@@ -3,6 +3,8 @@
 
 #pragma once
 
+#include <cstdint>
+
 #include "opentelemetry/ext/http/client/http_client_factory.h"
 #include "opentelemetry/ext/http/common/url_parser.h"
 #include "opentelemetry/sdk/common/env_variables.h"
@@ -26,7 +28,7 @@ inline const std::string GetDefaultZipkinEndpoint()
   return exists ? endpoint : kZipkinEndpointDefault;
 }
 
-enum class TransportFormat
+enum class TransportFormat : std::uint8_t
 {
   kJson,
   kProtobuf
diff --git a/ext/include/opentelemetry/ext/http/client/http_client.h b/ext/include/opentelemetry/ext/http/client/http_client.h
index 74fe793a2b..09c3c5b2dd 100644
--- a/ext/include/opentelemetry/ext/http/client/http_client.h
+++ b/ext/include/opentelemetry/ext/http/client/http_client.h
@@ -4,6 +4,7 @@
 #pragma once
 
 #include <chrono>
+#include <cstdint>
 #include <cstring>
 #include <map>
 #include <memory>
@@ -67,7 +68,7 @@ namespace http
 namespace client
 {
 
-enum class Method
+enum class Method : std::uint8_t
 {
   Get,
   Post,
@@ -78,7 +79,7 @@ enum class Method
   Delete
 };
 
-enum class SessionState
+enum class SessionState : std::uint8_t
 {
   CreateFailed,        // session create failed
   Created,             // session created
@@ -97,7 +98,7 @@ enum class SessionState
   Cancelled            // (manually) cancelled
 };
 
-enum class Compression
+enum class Compression : std::uint8_t
 {
   kNone,
   kGzip
diff --git a/ext/include/opentelemetry/ext/http/server/http_server.h b/ext/include/opentelemetry/ext/http/server/http_server.h
index a9925b609a..359a37062e 100644
--- a/ext/include/opentelemetry/ext/http/server/http_server.h
+++ b/ext/include/opentelemetry/ext/http/server/http_server.h
@@ -3,6 +3,7 @@
 
 #pragma once
 
+#include <cstdint>
 #include <functional>
 #include <list>
 #include <map>
@@ -95,7 +96,7 @@ class HttpServer : private SocketTools::Reactor::SocketCallback
     SocketTools::Socket socket;
     std::string receiveBuffer;
     std::string sendBuffer;
-    enum
+    enum : std::uint8_t
     {
       Idle,
       ReceivingHeaders,
diff --git a/ext/include/opentelemetry/ext/http/server/socket_tools.h b/ext/include/opentelemetry/ext/http/server/socket_tools.h
index eabfe78d79..4d5d60b418 100644
--- a/ext/include/opentelemetry/ext/http/server/socket_tools.h
+++ b/ext/include/opentelemetry/ext/http/server/socket_tools.h
@@ -6,6 +6,7 @@
 #include <atomic>
 #include <cassert>
 #include <cstddef>
+#include <cstdint>
 #include <cstring>
 #include <iostream>
 #include <map>
@@ -405,7 +406,7 @@ struct Socket
 #endif
   }
 
-  enum
+  enum  // NOLINT(performance-enum-size)
   {
 #ifdef _WIN32
     ErrorWouldBlock = WSAEWOULDBLOCK
@@ -414,7 +415,7 @@ struct Socket
 #endif
   };
 
-  enum
+  enum  // NOLINT(performance-enum-size)
   {
 #ifdef _WIN32
     ShutdownReceive = SD_RECEIVE,
@@ -469,7 +470,7 @@ struct Reactor : protected common::Thread
   /// <summary>
   /// Socket State
   /// </summary>
-  enum State
+  enum State : std::uint8_t
   {
     Readable   = 1,
     Writable   = 2,
diff --git a/sdk/include/opentelemetry/sdk/common/attribute_utils.h b/sdk/include/opentelemetry/sdk/common/attribute_utils.h
index a1ac74b239..351c36722c 100644
--- a/sdk/include/opentelemetry/sdk/common/attribute_utils.h
+++ b/sdk/include/opentelemetry/sdk/common/attribute_utils.h
@@ -49,7 +49,7 @@ using OwnedAttributeValue = nostd::variant<bool,
                                            std::vector<uint64_t>,
                                            std::vector<uint8_t>>;
 
-enum OwnedAttributeType
+enum OwnedAttributeType : std::uint8_t
 {
   kTypeBool,
   kTypeInt,
diff --git a/sdk/include/opentelemetry/sdk/common/exporter_utils.h b/sdk/include/opentelemetry/sdk/common/exporter_utils.h
index 091f481f9f..c25ff89bae 100644
--- a/sdk/include/opentelemetry/sdk/common/exporter_utils.h
+++ b/sdk/include/opentelemetry/sdk/common/exporter_utils.h
@@ -3,6 +3,8 @@
 
 #pragma once
 
+#include <cstdint>
+
 #include "opentelemetry/version.h"
 
 OPENTELEMETRY_BEGIN_NAMESPACE
@@ -13,7 +15,7 @@ namespace common
 /**
  * ExportResult is returned as result of exporting a batch of Records.
  */
-enum class ExportResult
+enum class ExportResult : std::uint8_t
 {
   // Batch was exported successfully.
   kSuccess = 0,
diff --git a/sdk/include/opentelemetry/sdk/common/global_log_handler.h b/sdk/include/opentelemetry/sdk/common/global_log_handler.h
index b700b9e398..2afaba85d6 100644
--- a/sdk/include/opentelemetry/sdk/common/global_log_handler.h
+++ b/sdk/include/opentelemetry/sdk/common/global_log_handler.h
@@ -3,6 +3,7 @@
 
 #pragma once
 
+#include <cstdint>
 #include <sstream>  // IWYU pragma: keep
 #include <string>
 
@@ -28,7 +29,7 @@ namespace common
 namespace internal_log
 {
 
-enum class LogLevel
+enum class LogLevel : std::uint8_t
 {
   None    = OTEL_INTERNAL_LOG_LEVEL_NONE,
   Error   = OTEL_INTERNAL_LOG_LEVEL_ERROR,
diff --git a/sdk/include/opentelemetry/sdk/metrics/export/metric_filter.h b/sdk/include/opentelemetry/sdk/metrics/export/metric_filter.h
index f21b9e8fc3..75f64b1e58 100644
--- a/sdk/include/opentelemetry/sdk/metrics/export/metric_filter.h
+++ b/sdk/include/opentelemetry/sdk/metrics/export/metric_filter.h
@@ -3,6 +3,7 @@
 
 #pragma once
 
+#include <cstdint>
 #include <functional>
 #include <memory>
 
@@ -35,14 +36,14 @@ namespace metrics
 class MetricFilter
 {
 public:
-  enum class MetricFilterResult
+  enum class MetricFilterResult : std::uint8_t
   {
     kAccept,
     kDrop,
     kAcceptPartial,
   };
 
-  enum class AttributesFilterResult
+  enum class AttributesFilterResult : std::uint8_t
   {
     kAccept,
     kDrop,
diff --git a/sdk/include/opentelemetry/sdk/metrics/export/metric_producer.h b/sdk/include/opentelemetry/sdk/metrics/export/metric_producer.h
index 6f9b7d3685..887f5067e5 100644
--- a/sdk/include/opentelemetry/sdk/metrics/export/metric_producer.h
+++ b/sdk/include/opentelemetry/sdk/metrics/export/metric_producer.h
@@ -3,6 +3,7 @@
 
 #pragma once
 
+#include <cstdint>
 #include <memory>
 #include <utility>
 #include <vector>
@@ -94,7 +95,7 @@ class MetricProducer
   MetricProducer &operator=(const MetricProducer &) = delete;
   MetricProducer &operator=(MetricProducer &&)      = delete;
 
-  enum class Status
+  enum class Status : std::uint8_t
   {
     kSuccess,
     kFailure,
diff --git a/sdk/include/opentelemetry/sdk/metrics/instruments.h b/sdk/include/opentelemetry/sdk/metrics/instruments.h
index 620fddedb5..5b5278fb2e 100644
--- a/sdk/include/opentelemetry/sdk/metrics/instruments.h
+++ b/sdk/include/opentelemetry/sdk/metrics/instruments.h
@@ -5,6 +5,7 @@
 
 #include <algorithm>
 #include <cctype>
+#include <cstdint>
 #include <functional>
 #include <string>
 
@@ -16,7 +17,7 @@ namespace sdk
 {
 namespace metrics
 {
-enum class InstrumentType
+enum class InstrumentType : std::uint8_t
 {
   kCounter,
   kHistogram,
@@ -27,13 +28,13 @@ enum class InstrumentType
   kGauge
 };
 
-enum class InstrumentClass
+enum class InstrumentClass : std::uint8_t
 {
   kSync,
   kAsync
 };
 
-enum class InstrumentValueType
+enum class InstrumentValueType : std::uint8_t
 {
   kInt,
   kLong,
@@ -41,7 +42,7 @@ enum class InstrumentValueType
   kDouble
 };
 
-enum class AggregationType
+enum class AggregationType : std::uint8_t
 {
   kDrop,
   kHistogram,
@@ -51,7 +52,7 @@ enum class AggregationType
   kBase2ExponentialHistogram
 };
 
-enum class AggregationTemporality
+enum class AggregationTemporality : std::uint8_t
 {
   kUnspecified,
   kDelta,
diff --git a/sdk/include/opentelemetry/sdk/trace/sampler.h b/sdk/include/opentelemetry/sdk/trace/sampler.h
index 28620189ca..888a44383b 100644
--- a/sdk/include/opentelemetry/sdk/trace/sampler.h
+++ b/sdk/include/opentelemetry/sdk/trace/sampler.h
@@ -3,6 +3,7 @@
 
 #pragma once
 
+#include <cstdint>
 #include <map>
 #include <memory>
 #include <string>
@@ -34,7 +35,7 @@ namespace trace
 /**
  * A sampling Decision for a Span to be created.
  */
-enum class Decision
+enum class Decision : std::uint8_t
 {
   // IsRecording() == false, span will not be recorded and all events and attributes will be
   // dropped.